Biomedical subjects
Publications and source records attributed to G L Ratner.
A new simple method of graft-to-vessel anastomosis using a stent technique that prevents blood leakage, stricture, and aneurysm formation is proposed herein. The advantages and problems related to its usage are also discussed.
The treatment of patients with bleeding duodenal ulcers is still one of the most complicated and discussable problems in surgery. The aim of this study was an attempt to predict the relapse of bleeding from ulcer of the duodenum on the basis of the experience in the treatment of 539 patients with this disease, 101 of whom underwent surgery. Diagnostic criteria for prognosis of repeated bleeding have been developed and the role of each of them in reliability of hemostasis in ecores was determined. It was established that indication for urgent operations for unreliable hemostasis is determined by the sum of 11 scores and more, as probability of bleeding recurrence in this situation in 90.2%.
Method of orthograde and retrograde forced bouginage for treatment of 533 patients with cicatricial strictures of the esophagus was used during 1975-1995 years (486 procedures). In comparison with routine methods it has shown high effectiveness and safety. Perforation of the esophagus was detected only in 2 (0.43%) patients. Good and favourable immediate results were obtained in 95.1% patients. Follow-up results up to 20 years are available for 336 (71.8%) patients. Good result was obtained in 78.6% patients, favourable--in 16.1%, poor results--in 5.2%. It is emphasized, that the principal method for treatment of patients with cicatricial strictures of the esophagus is bouginage. The method of orthograde and retrograde bouginage of the esophagus contributes to steady remission of the disease in 95% of patients.
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Long-term results of surgical correction of hyperlipidemia in 46 patients with obliterating atherosclerosis of lower extremities were compared with results of conservative treatment of 41 patients with the same pathology within the terms from 6 months till 5 years. It was shown that the surgical correction of hyperlipidemia resulted in more considerable and stable decrease of the blood lipid level as compared with the conservative treatment, in better course of the concomitant IHD and arterial hypertension.
Study of the blood serum lipid spectrum in 870 patients with atherosclerosis obliterans showed hypercholesterolemia in 24% and increased atherogenicity coefficient in 19%. In view of which, an operation for the formation of a partial iliac shunt was conducted in 33 patients with hyperlipidemia to reduce the blood lipid level and prevent the advancement of atherosclerosis obliterans. It was performed simultaneously with an operation for atherosclerosis obliterans in 15 of them. Twenty-three patients were studied in late periods, the level of atherogenic lipids in the blood was found to be decreased in all of them. The effect of the operation was positive in 17 patients, the process progressed in 3 patients. It is concluded that surgical correction of hyperlipidemia in atherosclerosis obliterans is an expedient measure.
Raynaud's phenomenon is a pathological condition with a multicomponent pathogenesis characterizing the community of mechanisms of the reactivity of the terminal microvessels of the extremities in response to standard stimulation. Raynaud's phenomenon is not a nosological form. In discovering Raynaud's phenomenon, however, differential diagnosis must be conducted to recognize the disease which caused the phenomenon. The diagnosis of Raynaud's disease, which is a nosological form, can be established by the method of exclusion of all such diseases. Raynaud's syndrome in the existence of diseases which are the primary cause is merely a precise diagnostic formulation.
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The article discusses the techniques of a two-stage combined separating intervention and instrumental division of the esophagus for the prevention and treatment of gastroesophageal hemorrhage in portal hypertension. The sequence of the stages of the operation is determined according to the emergency situation, the condition of hepatic function, and the presence of signs of hypersplenism. Separating interventions were carried out in 12 patients, one patient died in the immediate postoperative period. Complications were encountered in 4 patients. The patients who survived were examined in follow-up periods of 3 to 14 months, neither recurrent hemorrhages nor hepatic encephalopathy occurred. Varicosity of the esophageal and gastric veins disappeared and reduced in 10 patients.
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The article presents results of treatment of 219 patients with ulcer disease of the stomach and duodenum operated upon 20-25 years ago. The data presented prove the experience of antrum resection++ with selective vagotomy which may be operation of choice in patients with ulcer disease of the stomach and duodenum.
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It was found that in patients with gastroduodenal hemorrhage the number of serotonin-, histamine-, and melatonin-producing apudocytes in the gastric mucosa increases while the number of cells producing gastrin, adrenaline, and noradrenaline reduces. In timely arrest of hemorrhage, the primarily increased number of melatonin-producing apudocytes diminishes with time from the onset of bleeding and reaches normal values gradually. The essential differences in the content of melatonin- and noradrenaline- producing apudocytes in patients with and without hemorrhage allow this morphological sign to be used as diagnostic and prognostic criteria in gastroduodenal hemorrhages.
Nearest (44 patients) and long-term (35 patients) results of porto-systemic anastomoses were studied in portal hypertension. Five patients died in the nearest postoperative period. Recurrent bleedings were noted in 14 patients, hepatic encephalopathy--in 7 patients. Best results were obtained after making central spleno-renal anastomoses with the preservation of the spleen. Unfavourable factors were established which substantially influenced the survival rate of the patients at the nearest and remote periods. Indications to operation were found with special reference to the degree of portal hypertension and to unfavourable factors.
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