Biomedical subjects
Publications and source records attributed to V V Utkin.
The results of treatment of 53 patients with benign esophageal tumors are discussed. The diagnosis was mainly established by the radiologic and endoscopic methods. Leiomyoma of the esophagus was recognized in 29 patients, fibroma in 19, a cyst in 2, a polyp in 2 patients and a lipoma in one patient. Operations were carried out on 42 patients. Complications and fatal outcomes did not occur in the postoperative period. All patients recovered fully.
A method for creating laser enteric anastomoses was developed in experiments with YAG-neodymium and CO2 lasers. The properties of such anastomoses were studied in detail in the early stages after the operation. The use of serial Soviet-produced laser devices and standard surgical instruments in the experiments makes it possible to introduce the results of the work into clinical practice in the near future.
The authors analyse the results of diagnosis and surgical treatment of various forms of reflux esophagitis in 426 patients. The disease was caused by hiatal hernia in 60.4% of patients, by various operations on the cardia in 22%, and by gastric and duodenal ulcer in 8.2% of patients. Various diagnostic methods are evaluated, among which intraesophageal pH measurement and esophagofibroscopy are particularly important. The indications for operative treatment are formulated. Operations were carried out on 349 patients, complications occurred in 15%. The lethality was 0.6%. Nissen's fundoplication is the operation of choice.
The authors studied the biomechanical and acoustic properties of the esophageal wall as well as the roentgeno-optic density of the esophagus according to its anatomical parts in a wide age range. The mechanical properties were found to be heterogeneous and anisotropic. Their characteristics changed under the effect of atropine and acetylcholine. The property of being distorted and strength decrease in esophagitis, rigidity increases. The rate of spreading of ultrasound increases in compression and ageing but reduces in esophagitis. The obtained data make it possible to develop new methods of diagnosis and management of diseases of the esophagus.
One hundred forty eight patients with common forms of pulmonary tuberculosis in an outbreak phase and the presence of secondary immunodeficiency were observed. Caverns were found in 80.4% and bacterial excretion, in 87.16% of the cases. Group 1 (71 persons) received chemotherapeutic drugs only; group 2 (21 persons), chemotherapeutic drugs and T-activin; group 3 (33 persons), chemotherapeutic drugs and corticosteroids; and group 4 (23 persons), chemotherapeutic drugs, corticosteroids and T-activin. The bacterial excretion in all the groups was found to be the same. The regression of infiltrative changes in the lungs by the 6-th month of treatment was more significantly registered in the groups of patients on a regimen containing chemotherapeutic drugs, corticosteroids and T-activin. Cavern closure rate appeared to be the lowest in subjects receiving chemotherapeutic drugs and corticosteroids; the addition of T-activin increases the cavern closure index. The combination of chemotherapeutic drugs, corticosteroids and T-activin promotes the normalization of the cellular immunity and increases the efficacy of pulmonary tuberculosis treatment.
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A study of concomitant cases of alcoholism and pulmonary tuberculosis is reported, with reference to the incidence of alcoholism among the patients with pulmonary tuberculosis, causative relationships between the two diseases, clinical manifestations and course of pulmonary tuberculosis and alcoholism where the two are combined, as well as the treatment of alcoholism and pulmonary tuberculosis and its organizational aspects.
Seven patients with pseudocysts of the spleen were treated in the clinic of the 2nd chair of surgical diseases of the Riga Medical Institute. The cysts in all of them lacked characteristic signs and were recognized late, when they had grown to a large size. Ultrasonic examination and computerized tomography played the main role in establishing the diagnosis. The pseudocysts of the spleen were treated by surgery. In large cysts splenectomy was the operation of choice, though organ-preserving operations (enucleation of the cyst, resection of the spleen) were suggested.
Eight patients with abscesses of the spleen were observed. The clinical picture had no special characteristics. Splenomegaly was not a pathognomonic symptom of the spleen abscess. The ultrasonic investigation and computed tomography were the main methods of diagnostics. The timely treatment of the spleen abscesses gives satisfactory results. The operation of choice is thought to be splenectomy.
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A total of 53 patients after gastrectomy were examined by hepatobiliary scintigraphy with i.v. administration of 25 MBq of 99mTc-BIDA. Evacuation of the duodenal content proximally of enteroenteroanastomosis was revealed in 24 patients. Reflux-esophagitis was noted in 14 patients, in 10 of 11 patients, duodenal content got into the esophagus. The results of hepatobiliary scintigraphy were compared with those of endoscopic and x-ray diagnostic methods. A high informative value and significance of the results of hepatobiliary scintigraphy in the detection of reflux-esophagitis after gastrectomy were noted.
An estimation of functional results of gastrectomy for gastric cancer in 183 patients has been made. Radical operations with the formation of Y-shaped inter-intestinal anastomosis and an artificial food reservoir in the area of the small intestine portion anastomosed with the esophagus were performed in 102 patients. Macroscopic signs of reflux-esophagitis were noted in 2 patients (1.96%), dumping-syndrome in 4 patients (3.9%) and hyperproteinemia in 1 patient (0.98%), i.e. the operations performed gave favourable functional results.
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The results of 68 combined operations for lung cancer and sarcoma are presented. Postoperative complications occurred in 42.7% and lethality rate was 16.2%. Total survival was 41% at 1 year, 20%--3 years and 9.9% at 5 years. The results of combined surgery proved worse than those of surgical treatment of lung cancer. However, tracheobronchial combined surgery produced better results than vascular-atrial or parietal-diaphragmatic types.