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Biomedical subjects

A A Dovlatian

Publications and source records attributed to A A Dovlatian.

At least 19 recordsLinked to original sources
PubMed2005

[Diagnosis and conservative treatment of acute pyelonephritis in diabetes mellitus].

AIM: To raise efficacy of conservative treatment of patients with acute pyelonephritis (AP) which developed in the presence of diabetes mellitus (DM). MATERIAL AND METHODS: Elderly patients (n = 218, 182 females and 36 males) with DM and AP enered the study. DM type 1 and 2 were diagnosed in 41 and 177 of them. Pyelonephritis was diffuse-purulent, pyodestructive, calculous, pyocalculous. RESULTS: Conservative treatment was made in 160 patients, surgical treatment--in 58. Lethal outcomes (14 cases) were registered as a rule in patients with bilateral pyodestructive pyelonephritis. CONCLUSION: AP is a severe complication of DM. The severity of DM decompensation and metabolic disorders is proportional to AP severity. AP in diebetics runs often an asymptomatic course and the diagnosis is difficult. Therapeutic policy is individual with consideration of a clinical course. Positive results were achieved in 80% patients.

Aged↗
PubMed2005

[Long-term results of reconstructive surgeries in iatrogenic injury of the urinary tracts].

Various reconstructive surgeries were performed in 21 patients because of intraoperative injuries of the urinary tracts. In 4 patients trauma of the ureter and urinary bladder was associated with obstetric operations (Cesarean section, hysterectomy). In 13 cases injury of the ureter was the consequence of hysterectomy due to cancer (4), hysteromyoma (4), prolapses of the uterus (1), extirpation of the stump of the uterine cervix (1), electrocoagulation of the ureter (2) and adnexectomy (1). In 4 patients ligation of the ureter complicated surgery for cancer of the sigmoid colon (1) and rectum (1), diverticular disease of the colon (1) and portal hepatic cirrhosis with severe ascites. Surgical policy was organ-saving. Only in 3 patients with severe acute pyelonephritis surgical treatment was performed in two stages with preliminary nephrostomy. In the rest cases primary reconstructive surgeries were used. Reconstructive surgeries saved the kidney as a functioning organ.

Acute Disease↗
PubMed2004

[Surgical policy in acute purulent pyelonephritis in patients with diabetes].

Efficacy of treatment of 208 diabetic patients with acute pyelonephritis was analyzed. Surgical treatment was performed in 58 patients (43 with insulin-non-depended and 15 with insulin-depended types). All the patients were divided into 4 groups depending on forms of pyelonephritis: non-destructive (116 patients), purulent-destructive (58), calcllious (34), purulent-calculous (10). Algorithm of differential diagnosis between non-destructive and purulent-destructive forms of acute pyelonephritis in diabetic patients are presented. It is demonstrated that surgical treatment is the main method in complex therapy of purulent-destructive forms. Rational surgical policy is substantiated. In patient with diabetes and purulent pyelonephritis nephrectomy is more expediently. Nephrostomy may be used only in light forms of diabetes with local destructive forms ofapostematosic nephritis. Radical surgical policy permitted to achieve positive result of treatment in majority of patients. Lethal outcomes were seen in two-sided lesion of kidneys with apostems, and carbuncles.

Acute Disease↗
PubMed2003

[Results of treatment of isolated and combined trauma of urogenital system].

Retrospective analysis of treatment results of 608 patients with trauma of organs of urogenital system (UGS) was carried out. Beating was the cause of trauma in 55% cases, fall from height--in 17%, transport trauma--in 14.3%, knife wound--in 4.4%, gunshort wound--in 1.3%. Isolated trauma of UGS was in 481 (79.1%) patients. In other patients combined injury of UGS with injury of skeleton's bones (53), cranium and brain (25), abdominal organs (20) was diagnosed. In 29 patients severe combined trauma of UGS, abdominal organs, skeleton bones and cranium was seen. Surgeries were performed in 267 patients. Surgeries on kidney and urinary bladder due to their disruption predominated. In 44 patients these surgeries were combined with ones on abdominal organs. Surgery was performed in two stages in 25 patients with combined trauma of UGS and other organs. From 608 patients 552 (90.2%) cured. Lethal outcome was in 56 (9.2%) patients due to progressive traumatic shock.

Accidents↗
PubMed1995

[Therapeutic tactics and results of prostatic adenomectomy in the presence of aggravating factors].

Outcomes of radical surgery for prostatic adenoma have been analyzed for 426 patients divided into 3 groups. Group 1 included 160 patients subjected to urgent adenomectomy for acute urine retention, group 2 comprised 166 patients with severe intercurrent diseases subjected to one- and two-stage radical surgery, group 3 of 100 patients was free of intercurrent diseases. Urgent and delayed (within 72 hours and 5-10 days, respectively) radical adenomectomies are thought valid in management of acute urinary retention in patients with prostatic adenoma. Adequate preoperative preparation in deficient circulation, diabetes mellitus and other preexisting or concurrent diseases increased by 20-30% indications to the operation. Good outcomes were reported in 90%, 81.4% and 94% of patients from group 1, 2 and 3, respectively. 98.7% of 388 patients avoided suprapubic fistula and resumed natural urination. Only 1.3% of patients were discharged with cystostomy drainage of the bladder because of urethral stricture, urethrorectal fistula, renal failure and pyelonephritis. The differential approach provided good outcomes in 87.6% of seriously ill patients in overall hospital lethality 8.9%. The majority of the lethal outcomes resulted from purulent pyelonephritis (71%). The rest cases were due to acute affections of circulation, respiration and digestion.

Aged↗
PubMed1995

[Organ-preserving surgeries and nephrectomy in pregnant women with severe forms of acute suppurative destructive pyelonephritis].

The results of surgical treatment of pyodestructive pyelonephritis in 105 (4.2%) pregnant women and puerperae out of 2506 ones treated in the urology department from 1986 to 1994 are analyzed. Uni- and bilateral apostematous nephritis, carbuncle and abscess of the kidney were diagnosed in 89 and 16 patients, respectively. Nephrostomy was the principal method of treatment of focal suppurative forms of acute pyelonephritis. Bilateral nephrostomy was carried out in 12 pregnant patients, in 3 of them secondary nephrectomy was performed. Nephrectomy is indicated in total destruction of the kidneys, it was made in 37 (35.2%) pregnant women and puerperae. Introduction of radical surgery into practical treatment of neglected forms of pyodestructive pyelonephritis led to almost total liquidation of postoperative mortality in pregnant women. The efficacy of treatment of pregnant women is provided by varying in extension surgical interventions on the kidneys. Organ-sparing and radical operations in grave purulent pyelonephritis were effective in 97.2% of pregnant patients.

Acute Disease↗
PubMed1994

[Strategy and results of restorative surgery in urinary tract injuries in obstetric and gynecology practice].

The author analyzes the causes and types of intraoperative injuries to the urinary tract and the results of surgical repair in 10 patients exposed to various interventions on the uterus and the tubes. He advocates single-stage reconstructive repair in patients with acute injuries to the ureters which were not recognized in time. Immediate and late results of treatment were good in all the patients operated on.

Adult↗
PubMed1993

[The therapeutic preparation and management characteristics of patients following emergency prostatic adenomectomy].

Basing on the analysis of 136 urgent radical surgeries for acute retention of urine in prostatic adenoma patients, the author specifies indications for immediate and delayed adenomectomies. These were combined in a group of urgent adenomectomies because they were not preceded with cystostomy, being performed in one-stage for acute urologic disorders. Immediate operations (36.1%) were conducted within 3 post-admission days unless radical surgery was contraindicated. Delayed operations (63.9%) needed preoperative drug correction of complicating disorders, mainly cardiovascular. The operative risk arose due to complications of the adenoma itself, urological and cardiovascular diseases. Among the latter cardiac and cerebral ischemia occurred most commonly. It was proved useful to drain the bladder with a permanent urethral catheter when preparing patients for delayed adenomectomy. High efficacy (91.9%) of urgent adenomectomy for acute retention of urine in preexisting somatic diseases suggests its significant practical value.

Acute Disease↗
PubMed1993

[The treatment of acute pyelonephritis in pregnant women].

Analysis of 2058 pregnancy histories of patients with acute pyelonephritis helped work out and specify the indications for conservative and surgical treatment and characterize the etiopathogenetic factors and diagnostic methods. The necessity is emphasized of 'relieving' calix catheterization leading to elimination of retention shifts in the upper urinary tract and improving the efficacy of comprehensive antibacterial and detoxifying therapy. Methods and volumes of surgical interventions are substantiated.

Acute Disease↗
PubMed1993

[The treatment of acute suppurative pyelonephritis in diabetes mellitus patients].

The analysis of clinical, diagnostic and treatment efficacy data has been made for 160 diabetes mellitus patients (50 cases of insulin-dependent and 110 of noninsulin-dependent) with acute purulent pyelonephritis (APP). A diffuse form of the disease was detected in 100 patients (62.5%), purulent-destructive one in 60 patients (37.5%). Intoxication, resistant to insulin decompensation of diabetes mellitus, sepsis may be resultant from latent APP. Nondestructive forms of APP were responsive to antibacterial and detoxication therapy combined with catheterization of the urinary tracts. On demand, conservative therapy was reinforced with renal drainage by nephrostomy. Primary nephrectomy was recommended in purulent-destructive forms and purulent para-nephritis. Radical surgery in intensive and advanced purulent-destructive pyelonephritis produced a decrease in postoperative lethality by 26.8%. Adequate therapeutic policy provided positive results in 80% of the patients. Lethal outcomes (20%) were due to grave diabetes mellitus and APP.

Acute Disease↗
PubMed1992

[The validation of the adequacy of chemotherapy in bladder tuberculosis based on a study of bacteriostatic activity].

Study of the bacteriostatic activity (BA) of the blood, urine and tissue of the tuberculosis-affected urinary bladder after the administration of two tuberculostatic combinations (isoniazid + cycloserine and isoniazid + rifampicin) has demonstrated the difference in the BA curves that were formed in the above media. Use of isoniazid + cycloserine gives rise to a high BA level by 6-9 h with further gradual decrease of the parameters. The combination of isoniazid + cycloserine produces a typical double-humped curve with titre prolongation. The data obtained give evidence on the experience of the use of the first combination of the preparations in patients with fresh circumscribed urinary bladder lesions. The second combination (isoniazid + rifampicin) is indicated in the presence of ulcerous-cicatricial changes in association with a more prolonged circulation of the preparations in the organism (specific features of rifampicin metabolism).

Blood Bactericidal Activity↗