Biomedical subjects
Publications and source records attributed to V I Mamchich.
From 1992 to 2000 yr 79 patients were operated on for the thymoma, including I-II stage--33.3%, III stage--41.7%, IV stage--25%. Completed course chemotherapy was conducted in 12 (15.2%) patients, index of five-year survival in I-II stage had constituted 94%, in III stage--85% and IV stage--32%.
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362 patients with acute appendicitis (AA) were examined. For microbiological diagnosis of aerobic and anaerobic nonclostridial microflora we used complex accelerated methods (including evaluation of gram-negative microorganisms in comparison with tinctorial-fermentative method of differential staining according to oxygen sensitivity of catalasopositive together with aerobic and cathalasonegative anaerobic microorganisms) as well as complete bacteriologic examination with determination of sensitivity of the above microorganism to antimicrobial remedies. High rate of aerobic-anaerobic microbial associations and substantial identity of microflora from appendicis and exudate from abdominal cavity was revealed, which evidenced the leading role of endogenous microorganisms in etiology and pathogenesis of AA and peritonitis i. e. autoinfection. In patients with destructive forms of AA, complicated by peritonitis it is recommended to use the accelerated method of examination of pathologic material as well as the complete scheme of examination with the identification of the isolated microorganisms and the correction of antibiotic treatment.
Basic principles of infusion-transfusional therapy, methods of endoscopic hemostasis as well as indications for surgical treatment of acute hemorrhagic ulcers of the stomach and the duodenum are presented. If is stated that valid use of endoscopic methods of hemostasis provides possibility for temporal hemostasis in 70% of patients. It endoscopic hemostasis is ineffective in hemorrhage from ulcer or in recurrent hemorrhage it is recommended to perform urgent surgical interventions. To avoid the relapse of hemorrhage after endoscopic hemostasis from ulcer or revealing endoscopic symptoms of unreliable (unstable) hemostasis it is necessary to perform delayed operations (not later that 2 days from the moment of admission of the patients). If the hemostasis shows to be stable which is proved by endoscopy, early elective operations (in 12-14 days) are indicated.
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Results of surgical treatment of 271 patients with malady recurrence after perforative gastroduodenal ulcer closure were adduced. Resectional methods of treatment were conducted in 118 patients, vagotomy combined with the stomach draining procedure--in 106, in combination with ulcer extraduodenization and duodenoplasty--in 47. Conduction of organpreserving operation with ulcer extraduodenization and duodenoplasty must be supposed mostly rational.
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The method of plasty of the inguinal canal consisting in strengthening of its inferior wall achieved by means of placement of the sutures embracing the inguinal ligament permitting to prevent the development of its disfibration dissection and rupture of the fibers is suggested. One hundred and forty-one operation was performed. The long-term results were studied at the period of from 2 to 10 years. Disease recurrence was noted in 1 (0.7%) patient.
On the grounds of electron microscopy, histochemical, histological and macroscopic study of muscular scraps in different stages of their ischemia main mechanisms and principles of structural changes of skeletal muscles in occupational diseases of lower limbs vessels were followed. Clinico-morphological correlation in different degrees of skeletal muscle ischemia were established.
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The results of 76 relaparotomies performed for intraabdominal postoperative hemorrhage after emergency and elective operation on the abdominal organs are presented. The clinical features, diagnosis of profuse and capillary postoperative hemorrhage, causes and indications for relaparotomy performance are considered. Lethality in intraabdominal postoperative hemorrhage was 18.4%.
Treated were 193 patients with pyloroduodenal ulcer complicated by stenosis of gastric outlet. Compensated stenosis was noted in 14 (7.2%) patients, subcompensated--in 147 (76.2%), decompensated--in 30 (15.5%), gastric tetany--in 2 (1.04%). Studied were the immunologic indices, peripheric blood flow by means of a roentgenologic method under conditions of double contrasting and artificial hypotony, gastric and duodenal function, bioelectric activity--by the method of duodenokinesiography. Gastric resection was performed in 87 patients, vagotomy with drainage operation and without it--in 82, gastroenterostomy--in 14, antrum resection with vagotomy--in 12, Roux resection of the stomach--in 2. The postoperative lethality was 1%. Good and excellent results after gastric resection were noted in 82.1%, after vagotomy--in 88.4% of the patients.
The data on incidence of goiter in inhabitants of Kiev province for 5 years after Chernobyl accident, increase in number of operations performed for nodular forms of autoimmune thyroiditis and thyroid cancer are presented.
The authors analyse the specific features of the clinical picture, diagnosis, pathomorphological changes and surgical treatment in 52 patients with gastric ulcer which underwent malignant degeneration. It is noted that malignancy occurs most frequently in close vicinity to the ulcerative defect and rarely in the mucosa beyond the ulcer. The morphostructural reorganizations are determined to a certain degree by the peculiarities of extension of the tumor along the mucosa and the organ as a whole. The authors discuss the principles of the choice of the method for treatment according to the findings of pathomorphological examination of biopsy material and the results of emergency intraoperative examination. Even if the merest suspicion of malignancy of the ulcer arises, the operation should be conducted with observance of all oncological principles. Postoperative mortality was 3.8%, complications occurred in 7.7% of cases. Five-year survival was 84.6% in the absence of metastases and the presence of carcinoma cells within the limits of the mucosa and 12.5% among cases in which metastases were found during the operation. Attention is drawn to the principles of regular medical surveillance over patients receiving nonoperative treatment for gastric ulcer.
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