Biomedical subjects
Publications and source records attributed to V M Timerbulatov.
Anatomic cadavers studies have shown the necessity of one-stage abdominoplasty during herniotomy for ventral hernias. An original method of hernioplasty was developed. It is demonstrated that abdominoplasty in all the cases reduces tension of tissues with maximal effect in defects of the anterior abdominal wall from 32 to 150 cm(2) and subcutaneous fat thickness more than 3 cm.
Autotransplantation of splenic tissue in two patients after total duodenopancreatectomy and splenectomy for trauma of the duodenum and pancreas has demonstrated positive results and stable compensation of insulin insufficiency in two cases. Experimental studies of autotransplantation of splenic tissue carried out on 20 cats and 100 rats with pancreatectomy- and alloxan-induced diabetes demonstrated good results too. This method may be regarded as the variant of repair therapy with stromal stem-cells of the spleen.
The relationships between outcomes of severe acute pancreatitis (SAP) and organ dysfunction in 72 patients were studied. A total of 39 (54.2%) patients had organ dysfunction, 20 (27.8%) patients -- multiple organ dysfunction (MOD), 19 (26.4%) patients -- dysfunction of single organ or system. Died patients had higher incidence of MOD compared with those who alive (88.2 vs 9.1%, p<0.01). In multiple logistic regression analysis the main predicting factors of death were pulmonary failure and neurological dysfunction. Pulmonary failure was the most common organ dysfunction among both single organ dysfunction (57.9%) and MOD (95.0%), with a total morbidity of 41.7%. Mortality rate was lower at isolated pulmonary dysfunction, and was higher at MOD (18.2 vs 78.9%, p<0,01). Irregular specialized intensive treatment protocol led to groundless surgical interventions at 10 from 46 patients with sterile pancreonecrosis. Organ dysfunction makes worse the prognosis in patients with SAP. Choice of the optimal treatment strategy at SAP with MOD is determinative.
Criteria of laparoscopic approaches are substantiated. Advantage of combined procedures in difficult surgeries is proved. Microcirculation of the peritoneum and influence of different surgical approaches on it were studied. Minimal influence of minimally-invasive procedures on microcirculation is demonstrated.
Bashkirsky State Medical University served as an example for evaluating role of higher education institution in development of medical staffers in the region and their health care.
Results of hemorrhoidectomy in 185 patients were analyzed. In 82 patients of the study group surgery was performed with "LigaSure" generator. Control group consisted of 103 patients who underwent surgery by Milligan-Morgan method. Appliance of "LigaSure" generator to reduced time of surgery by 3.5 times (from 48+/-10.3 min to 13+/-3.7 min), pain syndrome -- 2.2 times, and dysuric disorders -- 2.4 times.
Results of treatment of postcolostomy patients are analyzed. In 74.7% cases colostoma was created due to tumor of the rectum or colon, in 6.5% -- due to diverticulosis, in 3.5% -- due to nonspecific ulcerative colitis, Krohn's and other diseases. Complications were diagnosed in 15.2% patients. Surgical treatment was carried out in 714 (43.6%) patients, 568 (79.5%) of them underwent reconstructive surgeries, 146 (20.4%) were operated for stoma complications. New methods of rectal stump preparation for surgery were used: method of differentiation of rectal stump and urether during surgeries, methods of delayed anastomosis. Laparoscopic mobilization of the colon during reconstructive surgeries led to a decrease of surgical trauma and number of complications.
The authors' experiences show that at the present-day stage of the development of mini-invasive surgery the combined method of operating consisting of laparoscopic and mini-laparotomic steps is a perspective alternative. In addition, the authors note high efficiency of combined operations having all advantages of mini-invasive surgical technologies which was confirmed by investigations of the effects of access on microcirculation of the peritoneum in different surgical accesses used in their clinic.
Results of surgical treatment with modern minimally invasive methods of 968 patients with isolated and combined abdominal trauma were analyzed. These methods permitted to make topic diagnosis earlier and to perform adequate surgery on injured organs in 82.0% patients, including in 34.0% with endoscopic-assisted operations, in 36.0% patients diagnostic laparotomies were avoided. In spleen trauma organ-saving and replacement operations were performed for prophylaxis of postsplenectomy syndrome. Vagodestruction of the stomach and pancreas with electromagnetic waves was successfully used in 32 patients for prophylaxis of traumatic pancreatitis and gastrointestinal ulcers. Minimally invasive technologies and organ-saving operations permitted to reduce intra- and postoperative complications rate from 29.7 to 16.8%, lethality--from 12.3 to 7.4%.
Results of examination and surgical treatment of 172 patients with internal biliary fistula (IBF) are analyzed. IBF was revealed in 0.22% of hospitalized patients with cholelithiasis. There were 4 variants of fistula formation. Combined spontaneous multiple fistula were described for the first time in 8 patients. Based on assessment of IBF's clinical symptoms formula for prediction of IBF development was proposed. Diagnostic potential of instrumental, X-ray, endoscopic and ultrasonic examinations was assessed. Differential surgical policy depending on IBF variant is described.
Ultrasonographic features of developed intraabdominal complications were in 73 patients, in 43 of them being local and in 30-diffuse peritonitis. The diagnosis was based on the complex manifestations of' sonographic changes of the small bowel and other organs of the abdominal cavity which the authors suggest to interpret as an ultrasound syndrome of "the bowel deficiency". The possibility of dynamic ultrasound control in postoperative period for registration of the features indicating elimination or progressing of peritonitis is shown.
The article presents the results of an experimental study of the possibility of using radiofrequency surgery for performing papillosphincterotomy. A generator of radiowaves of a high frequency range was used for the generation of the electromagnetic field, which when acting upon the living tissues makes a cut and destruction of the tissue. The experiment was made in 20 dogs divided into two groups for acute and chronic experiments. In the group of chronic experiments the dogs were exterminated on the 7, 14, 21 and 35th days after operations. The area of the influence in all the periods of the experiment was investigated histologically. Significant advantages of the given method as compared with the traditional ones were revealed.
Technical complexity and highly traumatic character of selective proximal vagotomy in all its modifications are considered to be the main causes of the postvagotomy complications. Experimental investigations in 38 mongrel dogs allowed the authors to develop and introduce into practice a new method of seromuscular proximal vagotomy with using radio waves. The selective destructive effect of the radio waves on the nerve tissues, evidenced by morphological investigations was taken into consideration and allowed the destruction of the vagus nerve branches in deep layers of the gastric wall to be performed. This method of vagotomy was used in 46 patients with ulcer disease of the duodenum and gave good results. When studying the functional state of the stomach and duodenum the authors widely used their modification of rheography of the gastric blood flow controlled by fibrogastroduodenoscopy in addition to routine methods of the functional diagnostics.
The results of treatment of 645 patients with diverticular disease of the colon have been analysed. There were 65.4% of women and 34.6%--of men, 54.4% of patients were hospitalized urgently and 45.6% electively. 82.5% of patients underwent conservative treatment, 24.8% of them were operated. In hyperkinetic type of bowel motor activity preference was given to mini-invasive organ-saving operations. In 28 cases Laparoscopic serosa myotomy by Reilly and Hodson were carried out (in 17 cases through miniapproach). In hypokinetic type various types of resection of the colon (20 patients) were performed. In necessity for urgent operation various methods of operations may be made depending on general condition of the patient and extension of the pathologic process. In 29 cases initial resection with anastomosis has been performed. Postoperative complications developed in 20.5% patients. There were no lethal outcomes. In 66 cases 2-stage operations were carried out, lethality being 10.6%, and complications--23.7%.
The results of surgical treatment of duodenal ulcer are presented. Combined miniinvasive method was used in 30 patients with perforated ulcers. The essence of the method consisted in laparoscopic sanation of abdominal cavity and operative manipulations in the area of perforated ulcer through mini-laparotomy approach. Taking into account destructive properties of radiowaves concerning nerve cells, the authors have proved in experiments feasibility of vagotomy by means of these waves, and used them for 10 patients in laparoscopic vagotomy combined with operative manipulations in the area of ulcer through mini-laparotomy approach. In 4 patients isolated laparoscopic radiofrequency vagotomy without gastric drainage in uncomplicated forms of duodenal ulcer was performed with good results.
The article analyzes results of treatment of 963 patients with cholelithiasis and with the complications of this disease. Operations on these patients were performed using the following methods: laparoscopy (422), minilaparotomy (373), wide (traditional) laparotomy (168). Recommendation for different ways of operations on biliary ducts are discussed as well as the necessity of taking into consideration the results of sonographical examinations, pathomorphological and rheographic changes when choosing a particular method of surgical treatment. A combination of two little-invasive methods of treatment of cholelithiasis complicated by peritonitis is suggested.
Results of examination and treatment of 128 operated patients were analyzed. In addition to clinical and roentgenological data the ultrasonic investigation and laparoscopy were also made for diagnosis of commissural ileus. Prevailing was terminal ileus (109 patients). Dissection of the commissures was performed in 115 patients, dissection of the commissures with resection of the intestine was made in 29 patients. Combined operations were fulfilled in 17% of the patients. Sonic stimulation of the intestine was used parallel with medication at the postoperative period which led to earlier restoration of the intestine function. Serious complications were noted in 19 patients, 14 patients died. Main causes of the death were intoxication and peritonitis, hepato-renal and cardio-vascular insufficiency.
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