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Biomedical subjects

P K Iablonskiĭ

Publications and source records attributed to P K Iablonskiĭ.

16 recordsLinked to original sources
PubMed2006

[Thirty-five years' experience of thoracic surgery].

The paper pools the experience gained in the surgical treatment of lung malformations in children and adults, which has been used to develop their current classification. It also presents the outcomes of surgical treatment of acute infectious lung destructions, by taking into account the Marchuk severity index. Modes of surgical treatment of bullous pulmonary emphysema have been provided, which yield minimum postoperative mortality rates (3%). The experience of surgical treatment of 110 patients with cicatrical tracheal stenosis is summarized. The authors also present the results of operations made in 390 patients with Stage III non-small cell carcinoma of the lung, specify indications and procedures for resection of the bifurcation of the trachea when the latter is involved in the tumorous process. They also summarize the experience gained in having performed more than 300 operations in the past 5 years for progressive pulmonary tuberculosis, with 2.7% mortality, and 106 final pneumonectomies for postoperative recurrent pulmonary tuberculosis. The experience with allografting of the trachea (n = 2) and lung (n = 3) is important and little studied in our country.

History, 20th Century↗
PubMed2005

[Comparative assessment of the effectiveness of traditional and videothoracoscopic thymectomies in complex treatment of myasthenic thymomas].

A retrospective matched-pair comparison was undertaken to evaluate the surgical and neurological outcomes after open and VATS thymectomy for patients with myasthenia gravis (MG) and thymoma. Ten women and seven men aged 14-77 years were operated upon in St. Petersburg Center of intensive pulmanology and thoracic surgery during the years 1995-2002. Results of two groups were compared: 1 - operated by VATS (9 patients) and 2 - operated via sterno- or thoracotomy (8 patients). The first step evaluated the distribution of age, gender, myasthenia severity, size, type of thymoma and Masaoka's stage. No difference between the groups was found. At the same time, the length of chest tube, blood loss, severity of postoperative pains were significantly lower in the first group as compared with the second one: 1.3+/-0.9 vs 6.2+/-4.5 days; 82.5+/-22.7 vs 557.1+/-212 ml; and 1.9+/-0.8 vs 6.1+/-1.2 points respectively. The number of postoperative complications was almost the same. All the patients were followed up during 24-96 months. There were no thymoma recurrences in the both groups. No statistical differences were found in MG course between the groups. A conclusion is made that VATS removing of noninvasive thymoma is technically feasible and safe for the patients. VATS thymectomy can provide the same results in MG treatment as the open approaches.

Adolescent↗
PubMed2005

[A technique of videothoracoscopic thymectomy in diseases of the thymus].

Intensive development of thoracoscopic thymectomy (Tthy) has been initiated during the last decade. Unfortunately very few instances of using the procedures have been described in Russian medical literature. So, the paper describes in detail the technique and results obtained in our clinic. At the period from 1998 through 2004 37 Tthy operations were performed in the St. Petersburg Center of intensive pulmonology and thoracic surgery. There were 21 female and 15 male patients with mean age 41.5+/-18.9 years. Myasthenia gravis (MG) was diagnosed in 19 of those patients. Different thoracoscopic approaches were used for Tthy: 20 from the right side, 15 from the left side and 2 combined approaches with neck incision. In 2 cases when invasive thymoma was suspected, sternotomy had to be used. There were 6 postoperative complications (1 haemothorax and 5 myasthenia cases). One patient died in 45 days after operation because of the ventilation-associated pneumonia. The results of treatment were followed up in 34 patients during 6-34 months. The MG course was followed up in 17 out of 19 patients, 9 (52.9%) being asymptomatic, 6 (35.3%) improved and 2 (11.8%) stable. Tthy is a novel technical possibility for a removal of the thymus gland. The procedure is quite safe and radical in the hand of a surgeon experienced in mediastinal and thoracoscopic surgery. Treatment of thymoma using Tthy requires meticulous technique and longer follow-up.

Adolescent↗
PubMed2005

[The role of an objective assessment of the heart right vientricle function for the anesthesiological maintenance and intensive therapy of surgical patients].

Latent dysfunction of the heart right ventricle and hypovolemia were assessed in 50 patients divided into 4 groups, operated on the heart, abdominal aorta and lungs. It was found that after revascularization of the myocardium the diastolic disorders prevailed. In patients operated for the heart valve (mitral and aortal) diseases prevailing were the systolic and pump dysfunction of the right ventricle. Insufficiency of the right ventricle in these groups was 13% and 22% respectively. After operations on the abdominal aorta a combination of the systolic and diastolic impairments of the right ventricle were observed. After extended resections of the lungs there was a characteristic combination of systolic, diastolic and pump dysfunctions. When the operation was followed by a decreased minute volume of circulation, its cause was hypovolemia in 29% of cases in the examined surgical patients. The investigation of the right ventricle functions with the help of pulmonary arterial volumetry can reveal their latent dysfunctions as well as hypovolemia in a considerable part of surgical patients.

Anesthesia↗
PubMed2005

[Diagnostic and treatment strategy for patients with the first episode of primary spontaneous pneumothorax].

A retrospective analysis of 198 patients (164 men and 28 women) with the first episode of primary spontaneous pneumothorax (PSP) was made. All the patients underwent diagnostic thoracoscopy (DT) under local anesthesia before insertion of a chest tube. For 115 patients the chest tube thoracoscopy was the only treatment procedure (group I) and 77 patients underwent video-assisted thoracoscopic (VATS) wedge (atypical) resection and pleurectomy (group II). The patients were followed-up from 13 through 77 months. In group I there were 19 recurrences (16.5%), and only two recurrences in group II. In patients of group II having no pathological changes there were no recurrences while in group I there were two (3.3%). The recurrence rate in patients with pathological changes (II, III and IV stages of Vanderschuren classification) was 3% after VATS and as high as 31.5% after the chest tube treatment. The diagnostic thoracoscopy should be performed in all patients with the first episode of PSP for the assessment of the lung and pleura condition. The presence of any pathological changes points to a high risk of recurrences and should be considered as an indication for antirelapse measures (VATS). Surgery is not necessary when no morphological alterations are revealed at DT.

Adult↗
PubMed2003

[The surgical lung volume reduction in patients with diffuse emphysema].

Twelve patients with severe chronic pulmonary obstructive disease complicated by a strong respiratory failure underwent lung volume reduction operations. An examination of the baseline functional parameters showed a significant outflow obstruction and lung hyperinflation. All the patients selected for the operation had a heterogeneous pattern of emphysema. Air leak from the lung suture was the main problem in the postoperative period. Long-term results were studied in 9 patients. A significant reduction of the respiratory failure and improvement of quality of life of the patients were noted. Significantly increased vital capacity, forced expiratory volume for 1 second, decreased residual volume and bronchial resistance were demonstrated.

Aged↗
PubMed2001

[Prospects for predicting the life expectancy of patients with chronic obstructive lung disease for refining indicators for lung transplantation].

Success of lung transplantation is largely determined by the patients' timely referral for surgery. However, the determinants of survival in patients with chronic obstructive pulmonary disease (COPD), potential lung recipients are to be established. To reveal the determinants of survival in patients with terminal respiratory failure, the data from a follow-up of 59 patients with COPD who met the generally accepted requirements for the recipients of an isolated lung were analyzed. The analysis of some clinical, functional, hemodynamic parameters established that the level of hypoxemia and the value of pulmonary systolic pressure were of the greatest prognostic value. The values of external respiratory function did not affect the patients' survival. Thus, patients with COPD should undergo lung transplantation if they have a pulmonary systolic pressure of over 50 mm Hg, pO2 of under 60 mm Hg, and no benefits from their conservative therapy.

Humans↗
PubMed1989

[The ultrastructure of the ciliary epithelium in patients with the Zivert-Kartagener syndrome, bronchiectasis and cystic hypoplasia of the lungs].

Ultrastructure of the cilia of the bronchial epithelium was studied in 26 patients with Zivert-Kartagener syndrome, 12 patients with bronchiectasis and 10 patients with cystic lung hypoplasia. All changes of the cytolemma and cytoskeleton are found to be of a combined type. The degree of the bronchial inflammation was of the decisive influence on the state of the ciliary cells. Common features of the ultrastructural alterations are noted in the groups of patients compared. Ultrastructural defects characteristic for the patients with the Zivert-Kartagener triad were not found. It is concluded that all the ultrastructural defects of the ciliary epithelium were of the acquired character.

Biopsy↗