Biomedical subjects
Publications and source records attributed to A A Beliaev.
The article discusses four patients who underwent operation for bezoars of the stomach at the Sklifosovsky Scientific Research Institute in a thirty-year period, which testifies to the rarity of the disease. The clinical picture, diagnosis, and the complications of the disease are considered. Special attention is drawn to the surgeon's tactics and the need to inspect the intestine during the operation.
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The article deals with some aspects of spinal anesthesia. It analyses in the light of possible complications the results of spinal anesthesia conducted in 4,186 cases with 1% sovcaine (cinchocaine hydrochloride) solution and 5% novocaine (procaine hydrochloride) solution by 60 surgeons. Spinal anesthesia was applied in patients, whose ages ranged from 11 to 96 years, in various operations. Contraindications for the method were determined. The author appraises comparatively spinal anesthesia with the related peridural anesthesia and discusses the prospects of the development of the method with the existence of new anesthetics and very thin needles for puncture of the subarachnoid space, which leads to the minimum number of possible complications.
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Hyperbaric oxygenation was used in the combined post-operative treatment of 63 victims with distal segments of lower extremities torn off or damaged by mine and burst effect. The patients consecutively received medicamentous therapy, which improved tissue microcirculation (rheopolyglucinum, haemodesum), surgical intervention, course of hyperbaric oxygenation, and after it anticoagulant preparations (heparinum) were used. The article shows that the combined application of hyperbaric oxygenation and medicinal preparation, that improve microcirculation in traumatized tissues, has a pathogenetic approvement.
In 50 patients undergoing direct revascularization of the myocardium, an attempt was made to carry out transesophageal echocardiography. In 5 of them, visualization of the myocardium appeared unsatisfactory, 2 patients were excluded from the investigation in view of the fact that they were operated on in the acute phase of myocardial infarction. Among 43 patients who were entered into the investigation, the areas of abnormal local contractility of the myocardium (AILC) occurred during surgery in 14 (33%). In 3 patients, the newly occurring disorders of local contractility of the myocardium persisted till the end of the operation. In the remaining cases, the presence of the AILC was temporary. The sensitivity of the newly occurring stable AILC in the diagnosis of perioperative myocardial infarction and acute coronary death amounted to 75%, specificity was 100%.
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The first experience in laser angioplasty of the superficial femoral artery in 5 patients is discussed. Local occlusion or critical stenosis (90% and more) of the vessel with signs of disturbed blood supply to the limb were the indications for the intervention. For conducting laser angioplasty the authors used an AIG-neodymium laser (1.06 microns) and a light guide of their own design which allowed a canal of no less than 3.1-3.9 mm in diameter to be formed in the plaque. Patency of the artery was restored in all 5 cases and a satisfactory clinical effect was produced. Thrombosis of the recanalized segment occurred on the 12th day after angioplasty in one case. The prospects of the method and the means of further studies are discussed.
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Laser angioplasty, using YAG-neodymium laser and a balloon catheter with monofiber quartz light guide (400 micron), introduced into its central canal, was performed in 8 dogs with thromboses of 11 femoral or carotid arteries. Average energy expenditure for recanalization was 26 +/- 4 J, with 4.9 +/- 0.3 W and exposure time of 5.1 +/- 0.7 s. Re-thrombosis developed after 5 to 10 days in all arteries, left in the circulation network after laser angioplasty. The latter part of the study is dealing with the assessment of the surface of femoral or carotid arteries of the dogs after laser exposure. This was done by quantitation of the adhered platelets after platelet-enriched plasma was circulated through vessels, whose inner surface was 1) intact, 2) de-endothelized, or 3) laser-damaged, using a scanning electron microscope. The thrombogenic index was 65-96, 85 and 66%, respectively, for the YAG-neodymium, argon and eximeric (XeCl) lasers.
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Thrombosis was induced in both canine carotid arteries by means of vascular wall flap inversion into their lumens. A red, completely occluding thrombus was formed inside the vessel 4 to 5 hours later. SmCo5 magnet was secured externally to one of the arteries. The constant magnetic field produced by the magnet had no influence on the clot formation. Autologous red cells loaded with ferromagnetic colloid compound and aspirin were administered intravenously through the hind paw route; total aspirin pool was 20 micrograms. Circulating magnetically-charged red cells have been earlier shown to concentrate in a canine artery in the constant magnet area. The administration of magnetically-charged red cells loaded with aspirin completely prevented arterial thrombosis in the magnet-supplied artery, having no detrimental effect on clot formation in the control artery.
Quantitative thrombogenic assessment of the inner arterial surface after laser exposure was made in 33 experiments with peripheral arterial strips of dogs. In one experiment, vascular strips with native, mechanically de-endotheliazed or laser-damaged surface were consecutively placed in a platelet-enriched plasma recirculation system, after which platelet adhesion was estimated on vascular surface of the three types, using a scanning electron microscope, and the relative thrombogenic index was calculated. The laser models used included: 1) the AIG-neodymium model, 1.06 micron; 2) the argon model with visible (488 and 514 nm) and ultraviolet (350 nm) spectra; 3) the XeCl excimer type, 308 nm, as well as a preheated metal rod, imitating a ceramic or metal tip of the light guide outlet. The thrombogenic index was 83 +/- 7; 72 +/- 8; 57 +/- 9; 63 +/- 7 and 82 +/- 9%, respectively, for the above types of exposure, the differences being virtually insignificant. It is suggested that, irrespective of the type of laser employed, laser angioplasty should at least be accompanied with intensive anticoagulant therapy.
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