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Biomedical subjects

L S Lokshin

Publications and source records attributed to L S Lokshin.

At least 19 recordsLinked to original sources
PubMed2003

[Surgical treatment of giant aneurysms of ascending parts and arch of the aorta in condition of deep hypothermia and circulatory arrest with artificial assisted circulation].

Sternotomy in giant (10 cm and more in diameter) aneurysms is highly dangerous due to possibility of injury of aneurysmatic wall with fatal bleeding. That is why sternotomy in condition of artificial circulation (AC) and cooling of patients to 29-30 degrees C are preferred. Two cases of successful surgical treatment of critical patients with giant aneurysms of ascending parts and arch of the aorta in condition of femoro-femoral AC, hypothermia (20 degrees C) and circulatory arrest are presented. One of the patients had a giant false posttraumatic aneurysm of an ascending part of the thoracic aorta with fistula between aneurysm and pulmonary artery. Suturing of defects of ascending aorta and pulmonary artery wall, aneurysmorrhaphia of pulmonary artery were performed. The other patient with acute disruption of a giant dissected aortal aneurysm and hemomediastinum underwent prosthesis of ascending part and arch of the aorta.

Aortic Dissection↗
PubMed2002

[Hypothermal perfusion: protection or damage?].

Ninety six patients were examined during operations on the open heart and great vessels: 25 perfusions were performed at a temperature of 30-32 degrees C; 41 perfusions at 26-29 degrees C; 10 at 23-26 degrees C; 20 at 12-14 degrees C. It was found that with superficial hypothermia and moderate PaO2, blood myoglobin (MG) release was minimal and the count and activity of platelets were optimal. The degree of myoglobinemia increased as PaO2 rose. As the body's temperature lowered, the blood concentrations of MG, its differences smoothed in the subgroups with different PaO2 values. Critical myoglobinemia (over 30 times higher than the baseline values) was noted in a group with superdeep cooling to a temperature of 14 degrees C. By taking into account the fact that the myocardium contains large quantities of MG, loss of this heme-containing protein involves myocardial blood supply disorders and hence decreased myocardial contractility. A considerable platelet loss entails higher postoperative hemorrhagic diathesis and requires efforts in correcting coagulopathies.

Body Temperature↗
PubMed2002

[Transplantation of the right hepatic lobe from an alive relative donor].

The use of relative donors in the transplantation of the liver has shown a good performance as an alternative line in its orthotopical grafting. Shortage of donor organs actively stimulates the development of relative transplantation. The main problem of relative hepatic transplantation is the limited capacity of obtaining a required mass of a hepatic graft for obese recipients. To settle this problem, the Russian Surgery Research Center, Russian Academy of Medical Sciences, has developed an original safe procedure for obtaining the right lobe of the liver from an alive relative donor and for implanting it in a recipient. In November 1997 to October 2001, transplantation of the right hepatic lobe from an alive relative donor was made in 23 recipients (10 males and 13 females aged 9 to 55 (mean 22.3 +/- 3.1) years. Their body weight was 24 to 80 (mean 51.4 +/- 3.0) kg. Indications for surgery were as follows: hepatic cirrhosis (HC) at the end stage of the Wilson-Konovalov disease (n = 10), primary sclerotic cholangitis (n = 4), HC of viral etiology (n = 3), Bailer's disease (n = 2), primary biliary HC (n = 2), HC in the presence of alpha 1-antitrypsin deficiency (n = 1), and secondary biliary HC (n = 1). The donors of the right lobe of the liver were recipients' mothers in 9 cases, their fathers in 6 cases, sisters in 2 cases, sons in 1 cases, their daughter, brother, aunt, cousin in 1 case each. The donors' age ranged from 19 to 49 (mean 37.9 +/- 1.4) years. The donors underwent right hemihepatectomy, complications were absent in them. There were early mortality among the recipients. Two patients died in the late postoperative period. The remaining 21 recipients were survivors and followed up for 1 to 48 (mean 14.9 +/- 2.9) months. Their life quality was good. The use of the right lobe of the liver from an alive relative donor is the optimum alternative to transplantation of the cadaverous liver and partially compensates the shortage of donor organs for children, adolescents, and adults.

Adolescent↗
PubMed2000

Platelet monoamine oxidase activity during surgical intervention under condition of hypothermic perfusion.

Platelet and plasma monoamine oxidase activity was determined at early stages of hypothermic perfusion and circulatory arrest. Monoamine oxidase activity decreased more drastically and restored more slowly against the background of deep (14 degrees C) compared to moderate hypothermia (26-29 degrees C). The decrease in platelet monoamine oxidase activity was accompanied by its increase in the plasma, which attests to mechanical (in tubes) and toxic damage to platelets. The latter is associated with increased partial O(2) pressure in the plasma during hypothermia, which promotes the formation of reactive oxygen species.

Adult↗
PubMed1998

[Role of academic B.V. Petrovskiĭ in the development of extracorporeal circulation].

The paper shows the role of Academician B.V. Petrovsky and his scientific school in the development of extracorporeal circulation, as well as his ties with S.S. Bryukhonenko (1890-1960), the founder of extracorporeal circulation in Russia. Heart-lung apparatuses were designed with the participation of collaborators of the Surgery Research Center (SRC), Russian Academy of Medical Sciences. A short account is given of the principal aspects of extracorporeal circulation, which have been studied at the SRC, such as protective blood flow distribution, centralization of circulation, the optimal perfusion rate, criteria for adequate extracorporeal circulation, control of blood coagulation and acid-base state, blood concentration, extracorporeal circulation with autooxygenation, hyperbaric perfusion, normothermal perfusion with continuous warm blood cardioplegia).

Extracorporeal Circulation↗
PubMed1998

[Orthotopic liver transplantation].

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management. This in turn provided longer survival for 80% of recipients. At the same time the mortality of potential recipients was 60.4%, which is due to the greater shortage of donor organs and which is the main problem in the development of organ grafting in Russia. The fact that there is a high proportion of children who are recipients for the donor's liver requires that liver transplantation from living related donors should be developed.

Adolescent↗
PubMed1997

[Orthotopic liver transplantation: surgery research center's experience].

From 1990 to 1996, 178 patients with severe diffuse and advanced focal liver diseases with grave prognosis were observed for indications to orthotopic liver transplantation (OLT). According to the revealed indications and contraindications, 95 patients were enrolled for the procedure. Eighteen patients underwent 19 OLTs, including 1 urgent retransplantation and 3 living related graftings. Surgical techniques were conventional; with these, intraoperative mortality and biliary complications could be avoided. Long-term survival (6 to 68 months) was achieved in 8 recipients, including in those after liver retransplantation. Double or triple suppressive regimens were used. These included corticosteroids, cyclosporin A, azathioprine, antithymocytic globulin. The life quality of recipients promoted restoration of their working capacities. Two recipients gave birth to healthy babies.

Adolescent↗
PubMed1993

[Orthotopic liver transplantation (first clinical experience)].

The article deals with the results of work conducted according to the orthotopic liver transplantation (OLT) program from January 1990 to January 1992. To select the patients for OLT, 54 persons (24 males and 30 females aged from 12 to 55 years) with diffuse (34) and focal (20) diseases of the liver were examined. OLT was indicated for 19 patients who were registered in the waiting list. In the period of waiting for the donor organs, 5 persons died, 3 refused to undergo OLT, and 4 remain on the waiting list. Eight OLT (including one retransplantation) were conducted on 7 patients. The indications for OLT in these patients were: unresectable hepatocellular carcinoma (4), cirrhosis of the liver of viral etiology (1), fulgurant form of hepatitis B (1), transplant rejection crisis which could not be arrested (1). Immunosuppression was conducted by the two- and three-component programs with the use of corticosteroids, cyclosporine A, and azathioprine. Eight crises of transplant rejection were encountered, successful retransplantation of the liver was accomplished for one of two crises which could not be arrested. The survival of the operated on recipients ranged from 3 days to 15 months. Various complications (mainly hemorrhagic and infectious) were encountered in the posttransplantation period. At the time that the article is written, 3 patients are living for 15, 9, and 4 months (after retransplantation of the liver in the last case), their condition is satisfactory. The death of the other recipients was caused by candidosepsis (on the 40th day), polyorganic insufficiency (on the 10th and 3rd days), sepsis (on the 12th day). The results of the liver transplantation program correspond to those of transplantation centers in other countries in the period of OLT mastering.

Adolescent↗
PubMed1990

[First clinical test of the use of artificial blood circulation with auto-oxygenation].

Thirteen operations for ischemic heart disease were performed in the All-Union Surgery Centre of the AMS USSR using the method of simultaneous left and right heart bypass with oxygenation of the blood in the patient's lungs. This method was found to provide for a better gas exchange in artificial lung ventilation (ALV) with 30 per cent oxygen in the inhaled mixture, and for the reduction in the perfusion blood damage. The biventricular bypass is more complicated technically than the conventional artificial circulation (AC), but it is believed to be more physiological and cost-effective, which allows for considering it an alternative in aortocoronary bypass surgery.

Adult↗
PubMed1990

[Experience in hemoconcentration by ultrafiltration in operations using artificial circulation at the All-Union Scientific Center of Surgery of the USSR Academy of Medical Sciences].

The article deals with the results of using ultrafiltration hemoconcentration in 649 operations conducted on the open heart with extracorporeal circulation at the All-Union Scientific Center of Surgery, USSR AMS during 1983-1989. The method allows control of hemodilution and colloid-osmotic pressure of plasma during the indicated interventions, lessens the loss of blood, and reduces the expenditure of donor blood.

Cardiac Surgical Procedures↗
PubMed1987

Three clinical methods of circulatory assistance.

Three clinical methods of circulatory assistance are described: intraaortic balloon counterpulsation, left ventricular bypass using a roller pump, and the artificial ventricle. All three methods have hemodynamic effectiveness. The first method is indicated in cases of widespread cardiosclerosis and pronounced coronary insufficiency and may be contraindicated in pathology of the valvular apparatus. The second method demonstrated a temporary positive effect in patients in whom it was not possible to discontinue artificial circulation. The artificial ventricle is useful in treating patients with cardiogenic shock following cardiac surgery.

Assisted Circulation↗
PubMed1982

Experimental and clinical ventricular bypass during acute heart failure.

Mechanical support of the failing heart in the form of bypass of the left and right ventricles by roller pumps was used in 25 dogs with model cardiogenic shock. Early application of left ventricular bypass in acute heart failure normalizes the myocardial bioenergy state and promotes reversible changes in myocardial ultrastructure as demonstrated by an increased surface area of mitochondrial cristae. On the basis of hemodynamics and morphology, we conclude that pump-aided bypass of ventricles without synchronization is a simple and effective method of circulation assistance. Mechanical support duration from 1 to 138 hours has been used in 10 patients following corrective heart surgery.

Acute Disease↗
PubMed1981

[Venoarterial perfusion without oxygenation as a means of mechanical aid to the heart in acute failure].

The efficacy of veno-arterial perfusion without oxygenation was established in experiments on dogs with a model of acute cardiac insufficiency. The overall index of circulation and the percentage of the heart participation in it is an important criterion of the effectiveness of shunting of the left ventricle. This criterion made it possible to determine the therapeutic role of veno-arterial perfusion without oxygenation in aiding the diseased ventricle even when the size of the shunt did not exceed 1/3 of the initial cardiac ejection.

Acute Disease↗
PubMedDate not supplied

[The left atrial-femoral bypass in operations on the descending aorta].

Fifteen patients were operated on for aortic aneurysms and were fitted with prostheses of the thoracoabdominal portion of the aorta in March 1997-February 1999. The operations were performed under conditions of a left atrial-femoral bypass with a centrifuge pump with a working heart. The patients were divided into 2 groups. In group 1 (10 pts), standard extracorporeal shunting and Cell-Saver were used, in group 2 (5 pts) the extracorporeal contour included an original system for rapid collection and return of autoblood. A left-atrial bypass prevented ischemia of the organs of the abdominal cavity and lower part of the body. Incorporation of a system for rapid collection and return of autoblood into the extracorporeal contour maintained stable hemodynamics, decreased heparin dose, preserved autoblood, and decreased the amount of transfused donor blood and its components.

Adult↗