[Surgical treatment of metastatic spinal tumors].
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Biomedical subjects
Publications and source records attributed to Kh A Musalatov.
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The course of hypostatic abscess in cervical spondylitis is analyzed, and its clinico-roentgenological manifestations are presented. The differential diagnosis between prevertebral abscess and thyroid tumors is described. The modes of application of endotracheal undulation in patients with cervical spondilitis and prevertebral abscess are suggested.
In order to study iron metabolism disorders in patients with portal hypertension syndrome, to determine clinical significance of hyposiderosis and to work out effective method of its correction, 94 patients with cirrhosis of the liver complicated by portal hypertension were examined. As a result of determination of these disorders of iron metabolism methods for treatment of hypochromal anemia and hyposiderosis have been worked out. Hemotransfusions, administration of iron-containing preparation Ferrum-lec and combination of these methods were used for treatment. It was established that administration of large doses of iron-containing preparation Ferrum-lec substantially contributed to improvement of iron metabolism in patients with cirrhosis of the liver and extrahepatic portal hypertension, to reduction of postoperative complications rate and to upgrading the results of surgical treatment.
The authors consider that puncture decompression of the intervertebral disc with using the endoscopic technique and laser evaporation is a method allowing to rapidly and effectively help patients with the root syndrome. All the manipulations are made with local anesthesia. The patients started walking on the second day after operation.
The paper presents the results of plastic operations on 54 trochanterian bedsores in 48 patients with complicated spinal injury. Early positive results were obtained in 100% of cases when various modifications of a skin-subcutaneous flap was applied in 16 patients with 17 bedsores. There were relapses in 4 patients following a year. A full-layer skin-subcutaneous-fasciomuscular flap was employed in 33 patients with 37 bedsores. A poor result, namely flap non-acceptance, was seen in one case. Late relapses were absent. It is most expedient to use full-layer flaps in the treatment of bedsores in the tronchaterian area in terms of its anatomic features.
Experimental studies have revealed that a pulse surgical laser based on alumo-yttrium garnet with neodymium ensures bloodless diskectomy and evaporation of a pulposus nucleus in the volume sufficient for decompression of the intervertebral disk. Biomechanical studies of spinal resistance following puncture endoscopic laser decompression of the intervertebral disk (PELDID) and microsurgical laser diskectomy (MLD) have demonstrated that these surgical interventions fail to disturb the stability of the spinal portion operated on. A total of 75 patients with radicular syndrome were operated on with the proposed procedures: 32 with PELDID and 43 with MLD. The subsequent studies have shown that 69 (92%) patients returned to previous work at week 7 and 5 (6.7%) at week 9 of postoperation. The major manifestation of radicular syndrome--leg pain--was eliminated in 100% after MLD and in 96.9% after PELDID.
A group of "Intost" materials based on carbon were developed by the I. M. Sechenov Moscow Medical Academy jointly with the Research Institute of Graphite. After experimental studies the materials were authorized for use in clinical practice for implantation. A concept of the design of endoprostheses of the joints from "Intost" was developed, on the basis of which unipolar combined endoprostheses of the hip joint (127 cases), metatarsophalangeal articulation (27 cases), humeral and metacarpophalangeal articulations (two cases each), and condyles of the tibia (5 cases) were made and applied in clinical practice. A detailed analysis is given of ten years of experience gained with the use of the combined unipolar endoprosthesis of the hip joint manufactured from "Intost-1" and "Intost-3". Long-term beneficial results were obtained in 95% of patients. Endoprosthesis is recommended for the treatment of fractures and false joints of the neck of the femur in elderly and senile patients.
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On the grounds of the experience with 72 cases of non-calculous cholecystitis the authors describe the characteristic features and sequelae of the disease. The authors recommend to use endoscopy methods widely with the goal to differentiate this pathology from any other biliary pancreato-duodenal pathology in order to elaborate adequate surgical indications for patients suffering from non-calculous cholecystitis.
The authors have summarized their experience with observations and treatment of 101 patients with cancer of extrahepatic bile ducts. Based on personal authors' findings it is concluded, that cancer of bile passages can frequently develop against the background of cholelithiasis. Taking into account little efficacy of surgical therapy, the prophylaxis of cancer development, namely an early operation for cholelithiasis, is believed by the authors to be the most effective measure.
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Biopsies and blood of 36 patients with bedsores developing due to spinal cord trauma were studied. Pronounced alterations in the blood content of IgA, IgM, IgG, a significant increase in circulating immune complexes (CIC) content and a decrease of neutrophil leukocyte chemotactic activity were found. The authors conclude that an immune system dysfunction occurs in patients with bedsores as well as secondary immune deficiency and immunoglobulin and CIC deposition in the granulation tissue vessels. Development of chronic vasculitis, obliteration and reduction of vessels, hypoxia and metabolic disturbances in the wound edges, formation of deficient fibroblasts synthesizing collagen type III which does not facilitate skin epithelium maturation, all these changes result in a chronic course of the wound and almost complete lack of healing.