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Biomedical subjects

A S Ermolov

Publications and source records attributed to A S Ermolov.

At least 19 recordsLinked to original sources
PubMed2006

[Structure of hospital lethality in polytrauma and ways to reduce it].

Case histories of 276 patients and autopsy protocols for patients who had died of polytrauma in 2002-2003 were analyzed. It was found that hospital polytrauma lethality is characterized by two peaks: within the first 24 hours after trauma (34.3% of the victims) and on day 4 and later after polytrauma (53.2%). Acute blood loss and shock are the cause of early lethality. In the period from 1 to 3 days after trauma the main causes of death are edema and dislocation of the brain in patients with dominating craniocerebral injury. Late mortality (on day 4 and later) is associated with infectious complications. The overall lethality after polytrauma decreased from 26-30% to 18.5-18.9% for the recent 10 years due to shortening of presurgical period, "cell-saver" use, improvement of anesthetic and intensive care management, mini-invasive osteosynthesis, timely prevention and treatment of brain edema, preventive use of last generation antibiotics and immune correction.

Aged↗
PubMed2006

[Diagnostics and treatment of traumatic myocardial infarction].

The authors describe their own clinical observations of four patients with acute chest injury, who developed myocardial infarction due to traumatic dissection of anterior interventricular artery intima and a subsequent thrombosis of the artery. The authors adduce clinicolaboratory characterization of traumatic myocardial infarction and describe early and long-term (three years) results of transcutaneous coronary operations (balloon angioplasty and stenting) performed in these patients.

Adult↗
PubMed2005

[Plastic surgery of postoperative abdominal hernias with polypropylene endoprosthesis].

One hundred and twenty-one patients with postoperative abdominal hernias of different size and location were treated, 103 of them underwent surgery with polypropylene endoprosthesis. Size of hernia was objectively assessed with an original method of X-ray-computed hernioabdominometry. The parameter presents as percentage of relative volume of hernia. Based on this index, hernias were classified by size in the following way: small -- relative volume 1.0 - 5.0%, middle-sized -- 5.1 -14,0%, large -- 14.1 - 18%, gigantic -- over 18.0%. Choice of a hernioplasty method depended on relative volume of postoperative hernia. Middle-sized hernias were indications for reconstructive surgery (complete adaptation of muscular and aponeurotic layers of abdominal wall), gigantic hernias - for correcting surgery (specified diastasis of muscular and aponeurotic layers was maintained). In large hernias the method of hernioplasty was individual depending on compensatory abilities of the patient. Postoperative complications (6.6%) were local and seen in 6.6% cases. There were no lethal outcomes and complications associated with endoprosthesis. Recurrences of hernia were not revealed in all 103 patients examined from 6 months to 2.5 years after surgery.

Female↗
PubMed2005

[Quantitative evaluation of blood loss severity in surgical practice].

AIM: To develop a quantitative method of evaluation of the volume and degree of intraoperative blood loss. MATERIAL AND METHODS: Blood loss quantitation is based on maximal collection of the lost blood and its measurement by lost globular volume (GV), i.e. erythrocyte containing medium with Ht 1.0. RESULTS: The total of the components of lost GV was termed estimated blood loss (EBL). Its amount was calculated by GV deficiency from the due in the patient and volume of lost blood. The method was tried in surgical and traumatological practice in 317 operated patients (multitrauma--65, hip bone fractures -98, uterine myoma -105, aneurysm of abdominal aortic part -49). CONCLUSION: The volume of blood loss guided the physician to reestablish volume of circulating blood--the volume of infused blood exceeded EBL 1.3-1.7-fold. GV deficiency (in %) showed severity of blood loss and gave approaches to its adequate compensation.

Blood Loss, Surgical↗
PubMed2005

[Immunological estimation of the degree and prognosis of acute pancreatitis].

An analysis of data of immunological investigation of blood of 89 patients with a severe acute pancreatitis (SAP) on the 2-3 day of the disease has revealed changes in immunogram characteristic also of other pathological conditions and pointing to a systemic inflammatory reaction. Among the patients who did not have purulent complications against the background of therapy of SAP, the character and degree of changes in immunogram were in line with average values, and so they could be considered as "a norm of pathology". A system of scores of impairments of the immune response to the destructive process was developed for an objective evaluation of the immune status of patients with SAP. In patients with a normal physiological immune response (sum of scores 0-5) the prognosis of the disease is considered to be good. No immunocorrectors should be included in the complex of treatment measures. In patients with an inadequate pathological immune response (sum of scores 9 and more) the prognosis is unfavorable. The complex of treatment measures for such patients should include immunocorrectors.

Adult↗
PubMed2004

[The method of choice for surgical treatment of intestinal obstruction in colon cancer].

The authors present the results of surgical treatment of 326 patients with cancer of the colon complicated by occlusive intestinal obstruction. Three degrees of colon passage disorders were distinguished. Surgical policy depended on location of the tumor, degree of the obstruction, severity of general state and concomitant diseases. General postoperative lethality was 13% (43 of 326 operated patients died). Resection of the colon and subtotal colectomy with one-stage intestinal reconstruction may be recommended for patients with compensated stage of intestinal obstruction and stable general state.

Adenocarcinoma↗
PubMed2004

[Surgery of cholelithiasis: from past to present].

Development of surgery of cholelithiasis is regarded. Classic surgical interventions on the gall bladder and bile ducts in complicated disease (acute cholecistitis, jaundice, cholangitis), postcholecistectomy syndrome, surgical trauma of the bile ducts are substantiated. To 1980s modern views on pathogenesis of the disease have been formed. However, unresolved problems of surgical policy, traumatism of open surgeries in complicated forms of the disease (postoperative lethality in acute cholecistitis was 37% and over) made results of treatment unsatisfactory. Correction of policy's problems, application of mini-invasive procedures, diapeutic approach and precision technique opened up-to-date period in surgery of cholelithiasis. It permitted to reduce postoperative lethality in acute and chronic course of the disease to 0.08 - 0.1%.

Cholecystectomy↗
PubMed2004

[Surgery of adrenal tumors].

From 1983 to 2003 examination and surgical treatment were performed in 463 patients with different adrenal tumors. Hormone-active tumors were revealed in 249 of them, non-active - in 214. Combination of CT or MRT with study of adrenal hormones is the basis of the diagnosis. In different cases multispiral computed tomography, angiography, selected taking of blood from inferior caval vein, US- or CT-guided biopsy were used. Open surgery through thoracofrenolumbotomy was performed in 392 patients, videolaparoscopic surgery - in 71. Expediency of laparoscopic surgery in line with open surgery is demonstrated.

Adrenal Gland Neoplasms↗
PubMed2004

[Gastroduodenal bleedings in critical illness].

Acute erosive lesions of upper parts of gastrointestinal tract with bleeding aggravate severe burn trauma, postoperative period after extensive surgeries and is the often component of polyorganic insufficiency syndrome. Gastric secretion in patients with severe burn trauma and neurotrauma was studied. Decrease of gastric secretory function due to central paresis of gastrointestinal tract and reflux of bile into stomach was seen in majority of patients with neurotrauma and acute gastric ulcers. On the contrary, in patients with burn shock increase of acid-secretory function of stomach was revealed. Schemes of prophylaxis and treatment of acute ulcers were developed. They included antacid therapy (for patients with increased secretion), regulators of motor-evacuatory function of stomach and intestine (for patients with paresis), drugs increased regenerative properties of mucosa, early enteral nutrition with balanced mixtures. This treatment in combination with hemostatic therapy and cure of main disease permitted to reduce number of gastroduodenal bleedings and lethality in these patients.

Burns↗
PubMed2004

[Surgery without donor's blood].

Complex program "Surgery without blood" was developed and introduced into a broad clinical practice. The main elements of this program are stimulation of erythropoesis, preparing in autoserum and autoblood before surgery with acute normovolemic hemodilution method, precise surgical technique, reinfusion of blood from wound and drainages, adequate anesthesia and correction of hemostasis system. This program permits one to minimize infusion of donor's blood components (DBC) in elective surgery (cardiosurgery, orthopedic surgery, neurosurgery, oncology, general surgery) and reduce significantly transfusion of DBC in urgent surgery. Rejection of DBC transfusion decreases number of postoperative complications and hospital stay, improves results of treatment and is cost-effective.

Blood Donors↗
PubMed2004

[Undeveloped high intestinal fistulas as an urgent problem of modern surgery].

Eighty-two cases of un formed high intestinal fistulas are analyzed. Degree of non-formation and volume of chymus loss are the main criteria determining treatment policy. Early surgery (one or two-sided switching of fistulas zone) is indicated in intestinal loss more then 600-700 ml per day or in complete fistula. Mezonnes surgery was un effective in the majority of cases. Special policy including trunk vagotomy, antrumectomy and plastic repair of the duodenal bulb permitted in the last years to avoid duodenal fistulas in the treatment of ulcer disease.

Adolescent↗
PubMed2003

[Instrumental diagnosis of reflux esophagitis].

One hundred and forty patients with clinical symptoms of gastroesophageal reflux disease were examined. Instrumental examination included esophagogastroduodenoscopy (140 patients) with target biopsy (44 patients), x-ray study of the esophagus and stomach (95), intragastric pH-metry (74), esophagomanometry (67). It is demonstrated that all the patients with clinical picture of gastroesophageal reflux disease suffer from reflux-esophagitis (RE) of various severity. Definite morphological equivalents correspond to each of endoscopic forms of RE. Complex instrumental diagnosis of RE must include intragastric pH-metry and esophagomanometry in line with esophagogastroduodenoscopy and morphological study. It is necessary to perform x-ray study in peptic strictures of the esophagus and in combination of RE with large axial hiatal hernias. Cardial or cardial-fundal hiatal hernia, increase of intragastric pressure and hyperacidity promote development of the most severe (destructive) forms of RE.

Adult↗
PubMed2003

[General issues of medical care in multiple trauma].

Experience in diagnosis and treatment of patients with combined trauma is presented. The clinicoanatomic classification of combined traumas with their division into 7 groups is proposed. The process of medical care is subdivided in 4 stages - prehospital, critical care, specialized clinical and rehabilitation. The number of patients and their qualitative characteristics at each stage are different. The majority of the lethal outcomes occur at prehospital and critical care stages. Improvement of medical care at the prehospital stage may be realized trough creation of diagnostic and treatment algorithms, at critical care stage - by adequate infusion-transfusion therapy and determination of surgical care priority. Prophylaxis and treatment of complications are very important at the second and third stages. At the rehabilitation stage 84,6% patients need treatment of locomotor lesions, 14.5% - damages of the brain, 0.5% - damages of the spinal cord. Traumas of the thorax and the abdomen don't require long rehabilitation.

Abdominal Injuries↗
PubMed2003

[Treatment of gastroduodenal ulcer bleedings in a general hospital of emergency care].

Treatment of patients with gastroduodenal ulcer bleedings in a general hospital of emergency care is a complex of measures including of endoscopic diagnosis and stopping of bleeding, use of effective antisecretory drugs with obligatory laboratory control of acid-producing function of the stomach, surgical treatment and eradication of H. pylori. Up-to-date methods of endoscopic hemostasis - spirituous infiltration, argon-plasma coagulation, clipping of vessels in ulcer and also their combination in difficult cases - provide reliable hemostasis and allow to avoid urgent surgery. Recently we succeeded in reducing the rate of urgent surgeries performed at the height of bleedings from 70 to 40%. These methods can be recommended for clinical practice because they reduce significantly lethality rates in patients with severe conditions.

Adult↗