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O S Shkrob

Publications and source records attributed to O S Shkrob.

At least 19 recordsLinked to original sources
PubMed1992

[The choice of an optimal variant in the reconstructive stage of gastrectomy].

The authors analyse 40-year experience in gastrectomy and extirpation of the gastric stump in carcinoma of the stomach. Operations were performed on 742 patients. The results show that the mechanical suture has advantages over the manual suture in the formation of the esophago-intestinal anastomosis. The functional results were found to be best when the continuity of the gastrointestinal tract was restored by establishing the esophago-intestinal anastomosis with a loop of the small intestine isolated according to Roux. Comparative appraisal of end-to-end and end-to-side esophago-intestinal anastomoses revealed the advantages of the last-named in relation to the incidence of postoperative complications and total outcomes. The effect of the surgeon's qualification on the frequency of postoperative complications is discussed.

Adult↗
PubMed1991

[Magnetic resonance tomography in the diagnosis of surgical diseases].

The authors analyse the first experience in the use of magnetic resonance tomography (MP-tomography) in the diagnosis of some surgical diseases. MR-tomography of the mammary gland (257 patients), thymus (55 patients), adrenals (41 patients), and hypophysis (18 patients) was conducted. The results of the examination were compared with the findings of other diagnostic methods and verified intraoperatively and histologically. The authors claim that the high informativeness of MR-tomography, its noninvasiveness, the absence of a radiation load, and the possibility of repeating the examination many times in three mutually-perpendicular planes distinguish the method favorably and dictate the necessity of its further study in clinical medicine.

Adrenal Gland Diseases↗
PubMed1991

[Intraoperative ultrasonographic examination in surgery of the biliary tract].

The diagnostic value of intraoperative ultrasonic examination (IUSE) in surgery on the biliary tract was shown from analysis of the literature and the authors' experience. IUSE in more than 300 patients demonstrated a high resolving power in the diagnosis of choledocholithiasis and the absence of radiation load, allergic reactions and complications. In comparison of IUSE with intraoperative cholangiography in the diagnosis of stones in the gallbladder the total efficacy of the methods was 98.2% and 92.6%, respectively. IUSE has no side effects, is a simpler and cheaper method of examination, and allows goal-oriented removal of stones from the biliary tract. It is shown that with accumulation of experience in IUSE the performance of intraoperative cholangiography can be brought to the minimum.

Adult↗
PubMed1991

[Generalized suppurative peritonitis in patients with destructive forms of acute appendicitis].

The authors undertook comparative analysis of the results of treatment, the number and intensity of postoperative pyo-inflammatory complications, and the mortality rate in a group of 51 patients with generalized purulent peritonitis of appendicular origin in various methods of abdominal cavity cleansing: closed drainage of the abdominal cavity (group I, 10 patients); continuous peritoneal lavage (group II, 15 patients), cleansing of the abdominal cavity in stages (group III, 26 patients). Any type of cleansing did not exclude the development of purulent complications during treatment, the whose number grew with the increase in the period between the appendectomy and the onset of the disease. Complications developed in 23 patients (45%). Their frequency and intensity were, however, much less when the abdominal cavity was lavaged in stages, which enable the number of cases of adhesive obstruction and the formation of abscesses between the loops to be reduced markedly. A progressive septic process and poly-organic insufficiency were the main causes of death. The mortality rate was 30; 26.6 and 11.5%, respectively, in groups I, II, and III.

Acute Disease↗
PubMed1991

[Diagnosis and surgical treatment of myasthenia gravis in childhood].

Thirty-year experience in surgical treatment of myasthenia in children and adolescents (175 patients) is generalized. It provides evidence of delayed recognition of this disease in many patients and of prolonged, often ineffective nonoperative treatment. Operation for thymectomy should be one of the main methods for the management of myasthenia in children. Operative treatment is indicated in a disease of moderate severity or in a severe course of myasthenia, particularly in patients with the first type of immunomorphological changes. It is important to amend the myasthenic disorders before the operation by means of maximally possible doses of anticholinesterases with addition of corticosteroids, whenever necessary. Whatever the method of treatment chosen, the patients must be kept under skilled dynamic control. Excellent and good late-term results were produced in 84.6% of cases.

Adolescent↗
PubMed1991

[Tactical and technical errors in surgical treatment of patients with generalized myasthenia gravis].

From experience in surgical treatment of 1,800 patients with generalized myasthenia as well as from literature data, the authors analyse the main tactical and technical errors in the treatment of this category of patients. A complex approach and a program of improving the results of treatment of patients with myasthenia were elaborated. Compulsory examination of the mediastinum for revealing possible affection of the thymus is indicated in myasthenia. Median sternotomy with ++extra-fascial removal of the whole thymus is considered the optimal approach in thymectomy. Thymomthymectomy with extensive removal of the areolar tissue of the anterior mediastinum is believed to be the operation of ++choice in tumors of the thymus. Thymus tissue which is not removed during the operation is one of the causes of recurrent myasthenia, while unjustified extension of the volume of the operation in nonneoplastic affection of the thymus is also inadvisable. Preoperative radiotherapy is not recommended. The principles elaborated in the clinic enabled the authors to reduce the frequency of assisted ventilation sevenfold and the incidence of infectious complications, pneumonia among others, to 0.6%.

Adult↗
PubMed1991

[Residual thymus gland in patients operated on for myasthenia].

The authors studied the causes of ineffective surgical treatment of myasthenia and found residual thymus to be one of them. From analysis of 21 cases in which part of the thymus was not removed (in 19 cases the diagnosis was verified histologically), they drew the conclusion that the causes of residual thymus may be technical errors due to inadequate choice of the surgical approach of the surgeons' insufficient experience, in removal of a thymoma failure to excise part of the thymus not involved in the tumor, incomplete knowledge of the role of the thymus in the pathogenesis of myasthenia and its incomplete removal in thymectomy in patients with generalized myasthenia. Uneventful postoperative course was noted in 11 patients, crises with respiratory disorders in 6 (prolonged artificial lung ventilation had to be resorted to in 4 of them), suppuration of the wound in 2, and pneumonia in 1 patient who was under artificial lung ventilation. The late--term results were studied in follow--up periods of 12 months to 15 years. The myasthenic status improved in all patients, the results were excellent and good in 15. In view of the difficulty in establishing the diagnosis and management, this grave category of patients must be treated at specialized centers.

Adolescent↗
PubMed1991

[Plasmapheresis in combined treatment of severe generalized myasthenia].

Experience in the application of plasmapheresis in various stages of treatment is analysed. It was conducted in 52 patients with severe forms of generalized myasthenia; 12 of them were males and 40 were females. It is noted that plasmapheresis is very effective in the preoperative period for the preparation of patients for operation and is ineffective in medicamentous therapy. In the late-term periods after thymectomy plasmapheresis is mainly recommended for arresting crises and precritical conditions because of the rapid and short effect of the method. In patients who underwent thymectomy and splenectomy the effect of plasmapheresis in the late-term period after the operation was of a longer duration. Research must be continued and clinical experience accumulated to identify exactly the mechanism of the effect of plasmapheresis on the myasthenic status and the immune and neuroendocrine systems and to determine the place of the method in the complex of therapeutic measures.

Adult↗
PubMed1990

[Splenectomy in the treatment of severe forms of myasthenia gravis].

The authors describe the results of clinical and electromyography examinations of 20 patients with grave generalized myasthenia, carried out within the short-term (up to 2 weeks) and long-term period (up to 1 year) after splenectomy. In these patients, the preceding therapy (thymectomy, gamma-therapy of the thymic area, the treatment with prednisolone, azathioprine, plasmapheresis, etc) had not produced any beneficial effect. The efficacy of splenectomy was assessed according to the Keens classification (A-E). In the short-term period after splenectomy the C effect was recorded in 13 out of the 20 patients. Out of 9 patients examined in the long-term period, the B effect was revealed in 3 patients, the C effect persisted in 3 patients, and 3 patients manifested the return to the initial status, namely to the E effect. Therefore in the group of patients with grave generalized myasthenia, the efficacy of splenectomy amounted to 65%. In view of this fact the inclusion of the given treatment method into the multimodality treatment of myasthenic patients is regarded advisable.

Adult↗
PubMed1990

[Splenectomy in the treatment of severe generalized myasthenia gravis (first experience)].

The authors discuss the results of splenectomy carried out on 20 patients with generalized myasthenia in whom previous complex treatment including thymectomy, corticosteroid and azathioprine therapy, repeated courses of plasmapheresis during medication with anticholinesterase agents, did not cause any essential improvement. Different values of homeostasis and immunological status were studied before and in different periods after splenectomy. The condition improved in 65% of patients, which was confirmed by the results of myography; the doses of corticosteroids and anticholinesterase agents were reduced. Bearing in mind the severe condition of patients selected for splenectomy, it is recommended to treat them only in medical centers possessing sufficient experience in treatment of myasthenia. The indications and contraindications for splenectomy in complex treatment of myasthenia must be specified further.

Adrenal Cortex Hormones↗
PubMed1990

[Surgical interventions in concurrent and concomitant diseases in patients with myasthenia gravis].

The authors analyse the recent 15 years' results of treatment of 51 patients with generalized myasthenia who underwent operation in the clinic for various surgical diseases. Forty-three of them had a history of operation on the thymus. The specific features of preoperative management, anesthesia, and postoperative treatment in this serious category of patients are discussed. It is concluded that it is expedient to hospitalize these patients in special surgical hospitals possessing experience in the treatment of patients with generalized myasthenia and the possibility of conducting long-term ventilation of the lungs and other measures of resuscitation.

Adolescent↗
PubMed1990

[Factors determining prognosis in stage T1.2NoMo breast cancer].

From study of data on 5- and 10-year survivals of 560 patients who underwent operation for breast cancer in stage T1.2NoMo, the authors determined the most significant prognostic factors. These were the histological form of the tumor and the degree of invasion into the adjoining tissues. The percentage of each studied factor was determined by mathematical analysis, which allowed the individual prognosis for each patient to be made and treatment planned accordingly.

Adult↗