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Biomedical subjects

E I Gal'perin

Publications and source records attributed to E I Gal'perin.

At least 19 recordsLinked to original sources
PubMed2006

[Chronic pancreatitis: resective and decompressive procedures].

PURPOSE: Definition of resective and decompressive operations in chronic pancreatitis. MATERIALS AND METHODS: A retrospective analyses of surgical management of 51 chronic pancreatitis patients is carried out. 24 patients underwent longitudinal pancreaticojejunostomy (PA), 27--pancreatic head ( PH) resective procedures: Beger--5, modified Frey (PH intraparenchimatose resection-- IR, supposing removal of fibrous masses from the ventral and greater part of the dorsal PH)--22. According to the character of the PH lesion the patients were divided in 3 groups: head dominant (13), total (11) and cystic pancreatitis (20). RESULTS: One early postoperative death developed after reoperation for adhesive intestinal ileus in patient with PA. No mortality was noted after IR. Remote results in terms of 4.8+/-0,7 years were studied in 32 (71%) patients underwent PA and IR. IR lead to good and satisfactory results. After PA poor results came to 5 (29.5%). CONCLUSIONS: Combination of PH IR and PA is indicated in head dominant and total chronic pancreatitis patients. In cases of pseudocysts and dilation of the main pancreatic duct (>6-7 cm) decompressive variant of procedure cysto-pancreato-jejunostomy is preferable.

Adult↗
PubMed2005

[Causes, diagnosis and surgical treatment of strictures of lobar and segmental hepatic ducts].

Causes of strictures of lobar and segmental ducts after their injuries during open and laparoscopic cholecystectomy in 53 patients were analyzed. For correction of bile outflow precision non-wireframe (n=22) and wireframe (n=20) anastomoses were used. In 10 patients a combined anastomosis was established. In 1 patient the external drainage of hepatic ducts was performed. After surgery 3 patients died. 1-15 year long-term results were studied in 48 (96%) patients. Good results were achieved in 29 (60.5%), satisfactory -- in 13 (27%) patients. Recurrences of the strictures were diagnosed in 6 patients. It is concluded that dynamic control is necessary in patients operated on for bile ducts injuries. Underestimation of remittent cholangitis leading to biliary cirrhosis worsens prognosis of the disease.

Adult↗
PubMed2004

[Diagnosis and treatment of different types of high scar strictures of the hepatic ducts].

Results of treatment of 224 patients with scar strictures of the hepatic ducts (BSDH) are presented. Based on Bismuth's classification of BSDH E.I. Galperin (2002) proposed own one. According to this classification there were 17 (7,6%) patients with type "+2" (stump of common hepatic duct - CHD more than 2 cm), 26 (11,6%) - with type "+1" (stump of CHD 1 - 2 cm), 72 (32,2%) - with "0" type (stump of CHD less than 1 cm), 54 (24,1%) - with "-1" type (upper fornix of CHD confluence is not affected), 35 (17,4%) - with "-2" type (CHD confluence is destroyed), 20 (8,9%) - with "-3" type (strictures of segmental ducts). There were greater number of previous surgeries in the patients with "-1" and "-2" types (p<0,05). Jaundice and secondary biliary liver cirrhosis were seen more frequently in types "0" - "-3". Hepaticojejunostomy was the surgery of choice. For approach to unaltered wall of hepatic ducts (HD) section of lobar ducts in types "+1", "0", excision of portal plate and partial resection of IV hepatic segment (31 patients) in "-1" - "-3" types were used. Exchangeable transhepatic drainage (ETD) was applied in 31 patients due to impossibility to excise scar tissues completely. In early postoperative period 9 (4%) patients died due to purulent cholangitis (7 patients) and insufficiency of anastomosis (2 patients). Long-term results were evaluated in 180 (80,4%) patients from 1 to 14 (6,6+/-3,9) years of follow-up. Thirteen surgeries were performed for repeated strictures. The main cause of restrictures was inadequate resection of scar tissues and unreasonable refusal of ETD (7 patients). Developed surgical technique in different types of strictures permits to reduce postoperative lethality and the rate of restrictures.

Adult↗
PubMed2003

Expression of prolactin receptors in human liver during cholestasis of different etiology and secondary liver cancer.

Indirect immunoperoxidase assay and computer analysis of photographic images revealed more intensive expression of prolactin receptors in hepatocytes of women compared to men. The intensity of expression was maximum in secondary liver cancer, high in obstructive jaundice of different etiology, and less pronounced in cholelithiasis. The expression of prolactin receptors in cholangiocytes was higher than in hepatocytes and was maximum during obstructive jaundice of different etiology. Cells of secondary tumors were characterized by low expression, while distant hepatocytes most intensively expressed prolactin receptors.

Adult↗
PubMed2003

[Diagnosis and surgical treatment of pancreonecrosis].

Actual problems of diagnosis and treatment of pancreonecrosis (PN) are discussed. Results of treatment of 154 patients hospitalized with sterile necrosis SN (n = 133) and infected PN (n = 21) were analyzed. SN became infected in 49 patients. The diagnostic methods were as follows: USE, CT, biochemical examinations of blood, urine and exudate. Percutaneous puncture contrast retroperitoneography (PPCR) was developed. It is demonstrated that modern diagnostic methods and PPCR permit one to diagnose PN, detect location, zone of retroperitoneal fat's necrosis and characterize its infection. The size of lesion of retroperitoneal fat in patients with sterile PN (n = 133) does not determine severity of the patients' condition and early lethality, but increases the risk of infection and makes worse prognosis of the disease. In laparoscopic sanation of the abdominal cavity for fermentative peritonitis, compared with laparotomic one, infection developed less rarely (10.2 and 40%, p < 0.01) and lethality decreased. Lethality in repeated mini-invasive surgeries through burso- and retroperitoneostomas performed in 34 patients with infected pancreonecrosis was 17.6% that is lower than one in repeated relaparotomies (n = 21, lethality 47.8%).

Adult↗
PubMed2001

[Treatment of extrahepatic bile ducts injuries due to laparoscopic cholecystectomy].

The department of hepatic surgery of I.M. Sechenov Moscow Medical Academy has gained experience of treatment of 25 patients with injuries of bile ducts inficted in laparoscopic cholecystectomy (LCE). All the patients underwent LCE in other hospitals. 4 patients were hospitalized with recent injuries (within 24 hours after injury) and 21--later. Injuries of the duct in LCE characterized by early clinical manifestation, injury in proximal portion of hepatic duct, technical difficulties of anastomosis creation during the first operation due to thin-walled duct of small diameter. Reconstructive operations yielded good results in 22 patients. Recurrent strictures were revealed in 3 patients who required repeated intervention. There were no lethal outcomes.

Adult↗
PubMed2001

[Selective-occlusive method of drug administration in the treatment of experimental liver tumors].

263 experimental studies on 184 rats were carried out. Hepatic tumors were provoked by intraparenchymatous implantation of 0.1 ml 20% tumoral suspension of mucous cancer (RS-I). Treatment was realized on 10-12 day after vaccination. Photodynamic therapy with "Photosense" (PS) and laser irradiation (670 nm, 50-100 Dj, 4-13 mm), and also catalytic therapy (CT) with "Teraftal" (TF) and ascorbic acid (AA) were used. FS and TF were administered by developed selective-occilisive method (SOM). Rapid accumulation of drugs in occluded lobe of liver was revealed in SOM, that permitted to decrease administered dose of TF in 16.5 times. There was no growth of tumor after FDT unlike control group. Same results were obtained after CT with SOM, but there was further growth of tumor after systemic administration of drugs. Developed SOM of drugs administration in FDT and CT lead to good results in treatment of experimental hepatic tumors.

Animals↗
PubMed2000

[Hepatoprotective action of phosphogliv in surgery of patients with chronic calculous cholecystitis].

32 patients with chronic calculous cholecystitis were treated by a new preparation. Phosphogliv (on the base of polyunsaturated phospholipids)--5 days before planned surgery and 5 days after. The increase of alanine and asparagine aminotransferases activities and of bilirubin concentration (2-2.5 fold) was observed in all the patients, cirespective of the drug treatment. However, the essential difference between treated and untreated patients was revealed in the course of post-operative period. In the control group asparagine aminotransferase activity and bilirubin level remained high, and alanine aminotransferases activity even more increased. In contrast, both two aminotransferases activities and bilirubin level fell substantially in Phosphogliv group, that may show more active liver regeneration after surgery. Besides, in this group operation did not result even in short-time changes of plasma protein fractions ratios--opposite to control. It may testify on some protective action of Phosphogliv on liver protein-synthesis system. The observed action of new phospholipid preparation Phosphogliv, together with the absence of side effects, allows to recommend it as an adjuvant in the surgery of patients with chronic calculous cholecystitis. Besides, the above results broaden usage field of polyunsaturated phosphatidylcholine as cell membranes repair agent: it appears to be effective not only for liver diseases treatment, but also for soonest overcome of post-surgery liver changes.

Bilirubin↗
PubMed1999

[Biliary sepsis: some peculiarities of pathogenesis].

Results of clinical study of 87 biliary sepsis patients and experimental study on 54 rats with obstructive jaundice and cholangitis are presented. Own and literary data are compared. Specific immune and portal haemodynamic changes, provoced by obstructive jaundice are main pathogenic factors defining specific course of biliary sepsis. These changes are: 1) gut bacterial and endotoxin translocation, portal endotoxaemia; 2) reduction of RES and Kupfer cell function and endotoxin break into the systemic circulation; 3) liver parenchyma ischemia and milliary abscess formation; 4) portal blood flow shunting into the general circulation additionally increasing systemic endotoxaemia. These factors determine rapid, even fulminate development of milliary abscesses of the liver and multiorganic failure. The authors suggest that etiologic and pathogenic factors, causing peculiarities of the clinical course should be indicated in the diagnosis of septic patient.

Animals↗
PubMed1998

[Iatrogenic injuries of bile ducts during cholecystectomy].

Having analyzed case histories 266 patients with cicatrical strictures of bile ducts, due to iatrogenic trauma in cholecystectomy who were admitted to clinic for reconstructive operation, the authors established that in 53% of patients the injury of bile ducts was not revealed during the operation. In missed bile ducts injury there were 5 varieties of clinical manifestations in the early postoperative period: 1) mechanical jaundice (72 patients); 2) exterior bile leakage (33 patients); 3) diffuse biliary peritonitis (23 patients); 4) mechanical jaundice and exterior bile leakage (5 patients); 5) mechanical jaundice and subhepatic abscess formation (6 patients). From 117 patients in whom iatrogenic trauma of the biliary tract was revealed in cholecystectomy, in 55 biliobiliary anastomosis was carried out, in 40--biliodigestive anastomosis in 22-external drainage procedure of biliary tract was accomplished. In the recent iatrogenic trauma of biliary ducts the authors have operated on urgently 12 patients, in 5 of which reconstructive operations were carried out (in 2--with removal transhepatic drainage, in 3--with T-shaped drainage) and in 7 patients--precisional biliointestinal anastomosis without framed drainage. In all the patients after reconstructive operation with T-shaped drainage in long-term period cicatricial stricture of hepaticocholedochus has developed. Favourable result was observed in patients after reconstructive operation with changeable transhepatic drainage and in patients with precisional biliointestinal anastomosis. The last variant of correction of the iatrogenic bile ducts T injuries is the most preferable. The external drainage procedure of bile ducts should be used when there are no suitable conditions for accomplishment of reconstructive surgery.

Adult↗
PubMed1998

[Treatment of cicatricial strictures fo hepatic ducts].

Retrospective evaluation of experience in treatment of 378 patients (1972-1997 years) with cicatricial stricture of hepatic ducts is presented. For the period for 1972 to 1986 years the basic principle consisted in obligatory use of a drainage--frame for prolonged (not less than 2 years) drainage of the biliary anastomosis aimed at a decrease of the recurrence risk. Changeable transhepatic drainage (CTD) was used. 199 patients were operated on, 18 died. In postoperative period a number of specific complications caused by CTD were observed: leak into infradiaphragmatic space (hemobilia, bile biliduodenal fistula, etc.). At follow-up period after restorative operations (34) relapse of cicatricial stricture was observed in 8 patients, which was a consequence of complications due to CTD. After reconstructive operations CTD was removed in 109 patients, relapse being detected in 5 (4.5%). Atraumatic needles with inert monifilament sutures as well as resolving suture threads enabled creation of high bilio-intestinal anastomoses without drainage-frame. Since 1987 to 1997 years 130 patients were operated on. Dissection of the hepatic ducts was made proximally to the cicatricial tissues, longitudinal cut of the left hepatic duct was performed. Atraumatic needles with threads of small size were used, the bilio-intestinal anastomosis was established by one layer nodular suture with nodules exteriorly faced and without seizure of intestinal mucous membrane. Complications in postoperative period were observed in 24 patients, no lethal outcomes occurred. In late postoperative period unsatisfactory results were documented in 7 patients. At present time we give preference to operations without drainage-frame. CTD is indicated in the presence of severe pyogenic and inflammatory infiltration at hepatic porta with involvement of the bile ducts' walls, cyrrhosis of the liver and portal hypertension hindering hepatic ducts' dissection; cicatricial stricture of the right hepatic duct followed by sclerosing process in sectoral ducts.

Choledochostomy↗
PubMed1994

[Endoscopic removal of calculi from the choledochus. Are there debatable questions in this problem?].

The article generalizes experience (1986-1991) in the treatment of 246 patients with choledocholithiasis with the performance of endoscopic papillosphincterotomy. Most patients (61%) were over 60 years of age, many had serious concomitant diseases. Among patients with occlusion of the bile ducts, 53.6% had obstructive purulent cholangitis, 53.6% had acute biliary pancreatitis, and 30.9% had acute cholecystitis. Typical as well as atypical cannulation EPST was applied. To exclude an X-ray load on the patient and doctor, the orifices of the terminal part of the common bile duct and of the main pancreatic duct were identified in most patients by an elaborated method of cannulation with aspiration control without preliminary contrast X-ray examination. After EPST the concrements were removed completely in 194 and partly in 52 patients. Complications occurred in 35 patients (bleeding in 5, acute pancreatitis in 8, acute cholangitis in 6, acute cholecystitis in 8, perforation of the duodenum in 1, and wedging of Dormia's basket in 8 patients. Eight patients died after EPST from unresolved purulent cholangitis and multiple cholangitic abscesses of the liver. The long-term results were studied in follow-up periods of 12 months to 7 years. Recurrent cholelithiasis was encountered in 2 patients. On the basis of the accumulated experience we believe EPST to be the method of choice in the management of: residual and recurrent choledocholithiasis, patients with cholecystocholedocholithiasis and operation risk factors, patients with acute biliary pancreatitis and acute obstructive cholangitis.

Acute Disease↗
PubMed1992

[Doppler ultrasonic evaluation of hepatic functional reserve].

Ultrasonic Doppler measurement of the blood flow in the portal vein and hepatic artery was conducted to evaluate the function and functional reserve of the liver in 146 patients with various forms of cholangitis combined with biliary cirrhosis and hepatic insufficiency. The functional reserve of the liver was judged by comparison of the basic blood flow on a fasting stomach with the blood flow after a functional histamine load. Five types of responses of the portal vein blood flow to the functional load according to the degree of disturbed hepatic function were revealed. Comparison of the flow of blood along the portal vein in healthy individuals with that in patients with diabetes mellitus and a formed splenorenal shunt showed that disconnection of the blood flow from the splenic vein has no effect on the flow of blood in the portal vein. The latter is regulated at the level of microcirculation in the liver, which is confirmed by the correlation between the blood flow in the portal vein and in the hepatic artery.

Biliary Tract Diseases↗
PubMed1991

[Disorders of organic hemodynamics of the liver and their correction in suppurative cholangitis].

The blood flow in the portal vein and hepatic artery was studied by means of ultrasonic Doppler flow measurement to investigate organic and regional hemodynamics of the liver in purulent cholangitis. The blood flow in the portal vein was found to be significantly diminished in patients with acute cholangitis and hepatic failure. Hepatic microcirculation was studied on a experimental model of obstructive jaundice and obstructive purulent cholangitis in rats by polarographic measurement of hydrogen clearance. Considerable reduction of the volume rate of the local blood flow was noted, and the degree of the reduction was related to the severity and duration of the disease. Decompression of the biliary tract by external drainage improved the local blood flow rate which, however, diminished again in prolonged external drainage. The use of pharmacological agents for correction of microcirculation in decompression of the biliary tract led to total and rapid correction of the volume rate of the local blood flow.

Acute Disease↗
PubMed1991

[Characteristics of surgical treatment of benign bifurcation strictures of the hepatic ducts].

Experience in the treatment of 195 patients with benign bifurcation stricture of the hepatic ducts is discussed. This group was made up of patients with the cicatricial process involving the region of the bifurcation or continuing to one or both lobar hepatic ducts. Two basic methods of bile--diverting operations were used: with carcass drainage (mono- and bilateral) of the anastomosis and hepatic ducts (n-155) and without a carcass drainage with the formation of a widecholecysto- intestinal anastomosis (through inclusion of the left lobar hepatic duct) by means of interrupted sutures without grasping the mucous membranes of the hepatic ducts and intestine (h-36). A combined method was used in 4 patients with an isolated stenosis of the right hepatic duct and an intact left hepatic duct. Intubation of both lobar hepatic ducts is considered necessary in patients with a bifurcation stricture in the existence of indications for carcass drainage of the bile-diverting anastomosis. Analysis of the immediate and late--term results showed that the postoperative period was more favourable in patients with bilateral carcass drainage of the bile-diverting anastomosis and in those with a precision anastomosis that in patients with monolateral drainage (complications occurred, respectively, in 16.3% and 46.6% of patients, and a good late-term results was encountered, respectively, in 78.5% and 55% of patients). The stricture did not recur in patients with a precision anastomosis and in those with bilateral carcass drainage.

Anastomosis, Surgical↗