Biomedical subjects
Publications and source records attributed to A I Nechaĭ.
Based on an analysis of data of ultrasonic examinations, cholangiography and operative findings, the authors consider that intraoperative cholangiography is necessary but in 48% of patients. The article gives grounds for indications to intraoperative cholangiography.
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A simple scheme for the examination of patients for identifying the causes of the so-called postcholecystectomy syndrome (PCES) is suggested from experience in the examination of 1,712 patients with this syndrome. Three groups of patients are distinguished. First group--individuals with an external biliary fistula. Second group--patients with jaundice or with signs of jaundice suffered in the past after an operation. Third group--patients with abdominal pain and dyspeptic disorders after removal of the gallbladder but without an external biliary fistula and jaundice. The author gives a clinical evaluation and recommendations for using in establishing the diagnosis ultrasonic examination, cholefistulography, intravenous cholegraphy, percutaneous transhepatic cholangiography, retrograde cholangiopancreaticography, and computerized tomography conformably to the distinguished groups. After the examination was completed, the need for a repeated operation or active treatment (endoscopic papillotomy, removal of stones through the fistula) occurred in 98.7% of patients of the first group, in 73.8% of those in the second group, and in 15.7% of patients of the third group.
The authors have made a detailed analysis of data of 112 patients who had injuries of bile ducts during investigations on the gallbladder (100 patients) or on the stomach (12 patients). There are many factors predisposing to casual injuries of organs during surgical procedures.
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Under analysis are results of vagotomy performed in 95 patients with uncomplicated ulcer of the duodenum after ineffective conservative treatment 10 years after operation. During this time recurrent ulcer developed in 26 patients (27.4%). The disease reappeared more frequently in patients with high level of night gastric secretion before surgery. Results of the operation in 25 patients (26.3%) could be estimated only as satisfactory because of various disorders (dumping-syndrome, diarrhea, gastric dyspepsia). But a usual basis for such an assessment was not a medial degree of some disorders (2 patients) but a combination of light degree disorders (23 patients). One patient was included into the IVth Wisik's group due to severe dyspepsia. Only 43 patients (45.3%) were included in the I and II groups by the Wisik's scheme. Results of vagotomy in patients who had no ulcer complications before operation were compared with the efficiency of vagotomy used totally for all indications and were found to be much worse. The authors make a conclusion that it is not expedient to widen indications to vagotomy at the expense of patients with uncomplicated ulcers.
Results of morphometry and count of certain kinds of endocrinocytes of gastric mucosa are analyzed. Pronounced proliferative alterations of the gastric mucosa were found with clear signs of the increased function of the structures responsible for acid gastric secretion. In part of the patients with ulcer disease of the duodenum there are considerable changes in the amount of certain kinds of endocrinocytes of the antral portion of the stomach, which form accumulations in the form of different fields and even focal zones. Such alterations in the gastric mucosa have correlative relationships with the level of acid gastric secretion.
An experience with diagnozing tumours of the adrenals in 159 patients has shown that overwhelming majority of the patients had hormonal disorders. Most important clinical signs taking place in various neoplasms of the adrenals were established. The minimum necessary volume of information is pointed out which must be obtained at each step of diagnozing.
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The article presents experimental grounds and clinical experiences for using a plasma device in 58 patients. Sufficiently high efficiency and safety of the method used during surgical procedures for arrest of bleedings from parenchymatous organs is proved.
Medical vagotomy with atropine allows two types of patients with duodenal ulcer to be distinguished--atropine-resistant and atropine-sensitive. A complicated course of the disease, high values of nocturnal gastric secretion before the operation, and positive Hollander's insulin test after vagotomy are encountered most frequently in atropine-resistant patients. The values of gastrin are significantly higher in these patients than in atropine sensitive patients. In 3-year follow-up periods, recurrence of the ulcer after vagotomy was revealed in 6.5% of atropine-resistant patients but in none of the atropine sensitive patients. Medical vagotomy with consideration for atropine sensitivity may be a reliable prognostic criterion in the choice of the operative intervention in patients with duodenal ulcer.
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The paper discusses data on 48 cases of Zollinger-Ellison's syndrome. Surgery was performed in 45 patients and ulcerated tumor (UT) found in 32. Tumor was detected in the pancreas (17 cases), duodenum, stomach, liver and parapancreatic fat tissue. Multiple tumors were detected in 3 patients. Twenty-seven percent of UT were genuinely or suspiciously malignant. A histological and clinical classification of gastrin-secreting neoplasms is presented. Surgical treatment for Zollinger-Ellison's syndrome presenting with UT and the results of surgery are discussed.
Gastric acidity was evaluated, using the histamine test (Key's test), measurement of nocturnal gastric secretion and gastric pH-metry, in 174 patients with gastric ulcers. Acidity proved to be lowered in 25% of gastric ulcers patients, normal in 30% and increased in nearly half of the patients. Intragastric proteolysis was studied in 48 individuals, including 27 patients with peptic ulcers and 21 normal controls. It was found to be normal in the overwhelming majority of peptic ulcer patients (74%). It is concluded that intragastric proteolysis can only be regarded as an aggressive factor, resulting in the formation of a gastric ulcer, when it is combined with high acidity.
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The work is based on the results of analysis of clinical material concerning patients who were treated by operation for duodenal ulcer 3-5 years earlier. Truncal vagotomy and pyloroplasty (TV + P) was performed in 166 and selective proximal vagotomy with pyloroplasty (SPV + P) in 195 patients. The authors found the long-term results to be similar in both groups and did not reveal any advantages of SPV + P over TV + P, in view of which they do not find it necessary in principle to decline from conducting TV + P at the present time.
Under investigation were results of gastric biopsies, tissues of ulcers dissected during operation and findings of an analysis of preparations in paraffin sections. Findings of all the three diagnostic methods were shown to be completely identical in 63 patients (chronic ulcer in 54 of them, malignant ulcer--in 9). Errors took place in 17 patients. Causes of the errors are discussed. Practical recommendations are given.