[Small intestine hemangioma as rare etiology of intestinal bleeding].
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Adult↗
Biomedical subjects
Sh I Karimov
Publications and source records attributed to Sh I Karimov.
[Choice of approach for transhepatic endovascular and biliary procedures].
Results of diagnostic and therapeutic transhepatic procedures in 185 patients with portal hypertension and 292 patients with obstructive jaundice are analyzed. Optimal angles for introduction of instruments, optimal intercost and the most convenient for manipulation biliovascular structures of the liver were determined. These principles permitted to reduce the failure rate in endovasculary procedures from 10.5 to 3.8%, in endobiliary--from 13.2 to 0.97%.
Biliary Tract Surgical Procedures↗
Endovascular embolization of the hepatolienal vessels in the treatment of portal hypertension.
PURPOSE: to study the characteristics and variants of changes in the structure of celiac trunk and portal vein pool vessels, to define the tactics of most effective use of endovascular interventions in the treatment of portal hypertension. MATERIAL AND METHODS: the immediate and long-term results of angiographic studies and endovascular interventions are analyzed in 329 patients with portal hypertension induced by liver cirrhosis. The compensated stage of portal hypertension was identified in 62, subcompensated in 93 and decompensated in 174 patients. The patients underwent embolization of the splenic, left gastric and gastro-omental arteries, varices of the esophagus and cardial part of the stomach. In the long-term period, appropriate corrective medical endovascular interventions were performed in the event of the identification of recanalization of the previously embolized vessels and occurrence of the collateral pathways. RESULTS: after embolization of the splenic artery the positive shifts in blood readings, reduction of the splenic size, and abatement of ascites were revealed in the majority of cases. In the long-term period, the efficacy of the procedure diminished as a result of restoration of the lumen of the previously embolized vessels or development of the collaterals which demanded repeat endovascular intervention. The hospital lethality among patients with portal hypertension who had been provided endovascular interventions because of esophageal bleeding accounted for 29.8%, with the incidence of early recurrences being equal to 4.8%. The best results were obtained in a group of patients who had undergone embolization of bleeding gastroesophageal varices coupled with occlusion of the splenic artery for decompression and intraportal infusion therapy.
Adolescent↗
[Optimization of surgical treatment of suppurative-necrotic lesions of the foot in patients with diabetes mellitus].
The analysis of treatment results in 559 patients with diabetes mellitus complicated by foot pyonecrotic lesions was carried out. Surgical treatment was performed in 448 patients considering route of infection spread (basic group), conventional methods of treatment were used in 111 patients (control group). It is shown that one of the causes of unsuccessful treatment results was the infection spread from foot to leg by toes tendons and synovial sheaths. The study of microbial contamination in wound exudate, distal and proximal sites of tendons revealed a significant difference in proximal-distal gradient for aerobes (2.8 +/- 0.19 lg/g) and anaerobes (1.71 +/- 0.16 lg/g, p < 0.01). Methods of surgical treatment of foot pyonecrotic lesions allowing for route of infection in patients with diabetes mellitus were developed. Use of these methods allowed to decrease more than 2 times the number of femoral amputations, and to increase the rate of surgical interventions with salvage of limb's support function from 71.2 to 87.7%.
Amputation, Surgical↗
[Minimally invasive surgery in cholelithiasis].
The results of minimally invasive surgical interventions (percutaneous transhepatic cholecystostomy, retrograde cholangiopancreatography with endoscopic papillosphincterotomy, percutaneous transhepatic cholangiostomy with endobiliary intervention, extracorporeal shock wave lithotripsy, laparoscopic cholecystectomy) in 1590 patients were analyzed, 2 methods and more were used in 74 of them. In 155 patients minimally invasive interventions were combined with open surgery. Rational combination of minimally invasive methods in cholelithiasis permits to cure majority of the patients, to avoid open operation and associated complications.
Adult↗
[Role of prolonged intraarterial catheter therapy in general peritonitis].
The analyses of treatment results in 82 patients with general purulent peritonitis are presented. In these patients long-term intraarterial catheter therapy (IACT) was included in the complex of postoperative treatment after elimination of infection source. Postoperative peritonitis was in 66 patients, 52 patients of them underwent reoperations for persisting general peritonitis. Use of IACT promoted arrest of abdominal inflammatory process and polyorganic insufficiency due to high concentration of antibiotics in the affection focus, improvement of regional circulation, reduced number of postoperative complications and a sharp fall of lethality of 8.5%.
Adult↗
[Peritoneal dialysis in treatment of diffuse purulent peritonitis].
Peritoneal dialysis (PD) as a method of sanitation of the abdominal cavity was used in treatment of 221 patients (140 males and 81 females aged 17-89 years) with extended purulent peritonitis. In all patients toxic (138) of terminal (83) stage of purulent peritonitis was diagnosed. PD was carried dut in flow-fractional regimen with the use of 10-15 l of isotonic physiologic solution with the addition of antibiotics and heparin 4 times per day during 4-6 days. Carrying out PD in patients with purulent diffuse peritonitis resulted in improvement of general condition of the patients, normalization of hemodynamics, diuresis, and in lessening the paresis of gastro-intestinal tract as well as decrease of intoxication. Thus, in the group of patients in whom PD was not used the mortality rate was high--36%, and including PD in the complex of treatment contributed to the decrease of lethality to 23%.
Adolescent↗
[Epidemiologic aspects of echinococcosis].
The performed studies showed, that morbidity of the population with echinococcosis substantially varies even within the boundaries of any administrative region and depends on a number of factors. According to climato-geographic conditions it is possible to single out three zones: arid zone (deserts, semi-deserts, salt-marshes) with minimal level of invasion of the population with echinococcosis; zone of semi-deserts and alpines with medium level of invasion; and zone of oases, valleys, middle-mountains and tugays--with high level of invasion. Among the risk group--cattle-breeders--2 subgroups could be singled out: steppe and mountains cattle-breeders, the risk of invasion in the laffer subgroup is substantially higher. It is necessary to include into the risk group also country housewives who are in constant contact with domestic animals, and schoolchildren who an in constant contact with dogs. The significance of aerogenic route of invasion is especially pronounced in children, and frequency of pulmonary form of echinococcosis has reached 50% and more. Besides studying the structure of morbidity and echinococcosis disease in relation to age, sex, occupational activities, for evaluation of epidemiologic conditions on territories it is advisable also to perform mapping of regions according to mass prophylactic examinations data with the use of serological reactions and US examinations, as well as to analyse epidemiologic conditions with the use of such criteria as indices of invasion, morbidity and detectability.
Adolescent↗
[Complications of transcutaneous transhepatic endovascular interventions in patients with portal hypertension].
Results of endovasal treatment of 196 patients with portal hypertension and its complications are analysed. The total rate of complications is 23.4%, the most serious of them were intraabdominal bleeding (2.5%), portal vein thrombosis (2.1%). The rate of mortality, related to the complications of transhepatic procedures, was 2.5%. The majority of the complications were specific to the character of the disease: liver cirrhosis, ascites, high portal pressure, coagulating system disorders.
Adolescent↗
[Symposium on Echinococcosis Surgery].
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Echinococcosis↗
[Dynamics of changes in brain metabolism in experimental peritonitis].
The condition of metabolic processes in the brain during the development of experimental peritonitis was studied in experiments on 100 unisexual pubertal rats weighting from 250 to 300 g. Blood samples were studied for the content of total protein, albumin, urea, total lipids, cholesterol, B-lipoproteins, and glucose with calculation of the arteriovenous difference (AVD) of each of these substrates. Marked phase changes in the character of metabolism of total protein, albumin, total lipids, B-lipoproteins, and glucose occur in the brain of rats with experimental peritonitis. It was found that energy and plastic substances were "washed out" of the brain of rats in the terminal stages of experimental peritonitis. In view of this it is pointed out that the complex of therapeutic measures applied in peritonitis must be critically revised and supplemented with agents which improve brain metabolism.
Animals↗
[Differentiated treatment of generalized peritonitis].
The article discusses the results of treatment of 327 patients with generalized peritonitis in the toxic and terminal stages. The patients were divided conditionally into three groups. In the first group (42 patients) treatment consisted in routine cleansing of the abdominal cavity with drainage and introduction of antibiotics into it in the postoperative period. Mortality was 45.7%, complications occurred in 52.6% of patients who had survived. In the second group (145 patients) peritoneal dialysis in the flow-drip regimen was applied 3 or 4 times per 24 hours in a volume of 3-4 liters. In this group mortality was 37.9%, the number of complications among the survivals was 41.1%. In the third group (140 patients) a complex of differentiated peritoneal therapy was employed, including the following developed methods: thorough intraoperative cleansing of the abdominal cavity with 10-15 liters of antiseptic solutions containing antibiotics chosen according to the results of express-bacterioscopy, "active" peritoneal dialysis in the flow-fraction regimen, as well as developed methods of laparostomy--controlled laparostomy, prolonged open administration with local cleansing and use of antibacterial ointments. With use of this complex, mortality reduced to 27.1% and the incidence of complications to 20.6%.
Acute Disease↗
[Radiographic endovascular correction of hyperaldosteronism in patients with arterial hypertension].
The authors describe a new method of X-ray endovascular destruction of the adrenal in patients with arterial hypertension and hyperaldosteronism. Destruction of the adrenal is accomplished by acute occlusion of its venous channel by introduction of a 3% thrombovar solution through a catheter installed in the central vein of the suprarenal gland. This method was applied in 22 patients with arterial hypertension; essential hypertension with secondary hyperaldosteronism was found in 18 of them, renoparenchymatous hypertension in 2, aldosteroma of the left adrenal in one, and Itsenko-Cushing's disease in one patient. Acute occlusion of the adrenal venous channel was achieved in 20 patients. The intervention normalized blood pressure in 16 and reduced it significantly in 4 patients.
Adrenal Glands↗
[Complications after removal of hepatic echinococcal cysts and possibilities of their prevention].
Operative treatment of hydatid disease is the only radical method at present. According to the data in the literature, the incidence of postoperative complications in patients with hydatid disease of the liver ranges from 14.32 to 64%. The work generalizes the results of operations in 278 patients with hepatic hydatid disease. Closed echinococcectomy was conducted in 168 (65.87%) patients, partly closed--in 34 (12.23%), open echinococcectomy--in 14 (5.04%), pericystectomy--in 21 (7.55%), ideal echinococcectomy--in 17 (6.12%), resection of the liver with removal of the hydatic cyst--in 15 (5.4%), and percutaneous transhepatic drainage of the cyst--in 9 (3.2%) patients. Postoperative complications occurred in 32 (11.51%) cases. Among them were suppuration of the residual cavity in 19, external biliary fistula in 11, and subdiaphragmatic abscess in 2 patients. The least number of complications was encountered after closed echinococcectomy--in 5 (2.97%) patients. One patient died after partly closed echinococcectomy as the result of development of multiple cholangiogenous hepatic abscesses. The results of the authors' observations provide evidence that the character and frequency of postoperative complications are determined by timely diagnosis of echinococcosis of the liver before the development of complicated forms, correct choice of the type of the operation, and the techniques of the operation and the operative approach.
Adolescent↗
[The absorptive-excretory function of the liver in patients with mechanical jaundice before and after endobiliary interventions].
The authors analyze the character and degree of disturbances of the absorbing-eliminating function of the liver in 156 patients with mechanical jaundice of different etiology. In patients with mechanical jaundice the absorbing-eliminating function of the liver is disturbed at early stages of the disease and these disturbances progress at longer terms of the disease. The restoration of the absorbing-eliminating function of the liver was noted in the process of percutaneous transhepatic drainage of the bile ducts.
Absorption↗
[Endovascular surgery and the validation of immunocorrection in patients with liver cirrhosis complicated by portal hypertension].
An analysis of results of complex clinico-immunological studies in 110 patients with liver cirrhosis complicated by portal hypertension has been made. A scheme of immunocorrective therapy with T-activin in patients with liver cirrhosis complicated by portal hypertension is substantiated and developed for performing roentgen endovascular interventions.
Adjuvants, Immunologic↗
[Surgical tactics in associated echinococcosis of the liver and lung].
Over 10 years operations were conducted in 28 patients with hydatid disease with concurrent involvement of the liver and lungs, which accounted for 5.76% of all patients with hydatid disease of the thoracic and abdominal organs. The following variants were encountered: uncomplicated echinococcosis of the right lung and right hepatic lobe (13 patients); uncomplicated echinococcosis of the left lung and liver (3); suppurative hydatid cyst of the liver with rupture into the pleural cavity and the development of pyothorax (9); rupture of a hepatic hydatid cyst into the bronchial tree of the right lung with the development of a cysto-bronchial fistula (3 patients). In the group of 28 patients with concurrent involvement of the liver and lung 18 were operated on through a thoraco-phreno-laparotomic approach, 9 through a transpleural approach, and one patient underwent a two-stage operation. The success of the treatment is determined by early recognition of the concurrent echinococcosis and the choice of the optimal surgical tactics. One-stage echinococcotomy from the liver and lung is the operation of choice in concurrent affection of the liver and right lung.
Adolescent↗
[Transcutaneous endobiliary interventions in mechanical jaundice].
The authors analyse experience in the treatment of 132 patients with obstructive jaundice which was caused by a neoplastic lesion in 61 and by a benign disease in 71 of them. Bearing in mind the serious condition of this category of patients and the high risk of the operative intervention, two-stage treatment is applied with preliminary decompression of the biliary system and restoration of the main hepatic functions in the first stage. Transcutaneous endo-biliary interventions are carried out when other sparing methods cannot be accomplished or are ineffective. The authors give an integral, finer evaluation of the functional condition of the liver, elimination of the biliary microflora, and in this manner develop the criteria of the indications for the second stage of the intervention (prolonged bile passage in the intestine). In view of the high risk of the operative intervention, the authors suggest wider use of the methods of transcutaneous endo-biliary interventions according to indications. Nine patients died (6.8% mortality) in increasing hepatorenal insufficiency with growth of the oncological process.
Adult↗