Biomedical subjects
Publications and source records attributed to M P Korolev.
The authors made an analysis of their experiences with treatment of 52 patients. The algorithm of examinations and treatment depending on the character of the injury of the esophagus and stomach is described. Positive results were obtained in 90% of the patients.
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The authors made an analysis of their experiences with treatment of 101 patients with injuries of the pancreas. Choice of the most rational surgical treatment of injuries of this organ depends on the degree and character of the injury. In 80% of the patients the development of traumatic pancreatitis was noted. Surgical prophylactics of this disease including wide mobilization, drainage etc. allowed the authors to decrease the amount of complications and of lethal outcomes. Thirteen patients (12.9%) died out of the observed patients because of severe combined injuries.
The authors made an analysis of variants of treatment strategy and its results in patients with different forms of erysipelas. The use of complex conservative and operative treatment allowed lethality to be reduced from 4 to 1.9%, in patients with severe course of the disease the frequency of complications being reduced to 10%.
Results of the examination and treatment of 61 patients with chronic gastroduodenal ulcers complicated by bleeding have been analyzed. The possibility is shown to use hemoglobin indices for the estimation of severity of bleedings and for determination of indications for preoperative hemotransfusion to patients with chronic gastroduodenal ulcers complicated by bleeding. It was found that to refuse or reduce blood transfusion at the preoperative period was possible depending on the initial level of hemoglobin with the purpose of blood saving and in order to decrease the risk of reactions to hemotransfusion and complications.
An experience of work of the department of general surgery with the course of endoscopy is presented. The endoscopic diagnosis and treatment of 2931 patients for 6 years were performed for bleedings from the upper parts of the gastrointestinal tract. Errors in endoscopic diagnosis made 5%. The authors divided them into three groups: methodical (preparing the patients, methods of examination), diagnostic (assessment of the substrate and type of bleeding, probability of recurrences), tactical (medical policy, dynamics of observations). Hemostasis in endoscopic arrest may be complete or temporary (stable or unstable). The most effective methods are thought to be coagulation, clipping and a combination of the methods. Medicamentous means are less effective. The authors recommend to be aware of the endoscopic possibilities and not to try to stop bleeding by any means thereby wasting time.
Characterization of foreign bodies and their localization in the digestive tract in 404 patients is given. Surgical methods of treatment of such patients are described. Endoscopy was used for examination and treatment. The adequate anesthesia is thought by the authors to be necessary for a successful endoscopic removal of the foreign bodies. The indications for general anesthesia are enumerated. The endoscopic removal of the foreign bodies during surgical interventions are indicated in patients with the perforation of the esophagus by a foreign body.
The article presents an 11 years experience in work of a specialized department of thoracoabdominal trauma with an analysis of treatment of 292 wounded. The main causes of the thoracoabdominal wounds (TAW) were knife stabs (96.2% of the patients). The diagnosis of injuries to vital organs of the chest and abdomen is known to be very difficult. The X-ray analysis is one of major diagnostic methods for TAW. Emergency thoracoscopy is of great significance in diagnosis of intrathoracic injuries and laparocentesis and laparoscopy are of great value for intraperitoneal wounds. The sequence of measures and surgery volume must be determined by the wound type and the severity of injuries of the internal organs which gives better results of treatment of such patients. Postoperative complications were noted in 9.1% of the wounded. Lethality was 5.1%.
The authors analyze an experience with treatment of 2750 patients with different forms of nonlactational mastitis. Special attention is given to peculiarities of the clinical course of the disease, importance of early diagnosis of the inflammation in the mammary gland. Pathogenetical treatment of different forms of nonlactational mastitis is substantiated. Dissection of all pathogenetically altered tissues is thought to be necessary in operative treatment of patients with purulent forms with the following histological investigation.
Under analysis were results of surgical treatment of 47 patients with injuries of the aorta, major arteries and veins. Higher lethality was noted in people with injuries of major veins, especially vena cava. Specific operative methods are described for various kinds of injuries of the vessels of the thoracic and abdominal cavities. Lethality was 25.5%.
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The article sums up an experience with treatment of 342 patients with injuries to the liver at a specialized unit for thoracoabdominal trauma. Under analysis are problems of diagnosis, classification, surgical policy and causes of lethal outcomes.
Dieulafoy's lesion is one of numerous causes of acute gastrointestinal bleedings. A prospective study of the Dieulafoy lesion were carried out from 1989 till 1995. Under study there were 8 patients. Acute Dieulafoy ulcers are most often localize in the upper third of the stomach and cause massive bleedings. The authors consider urgent laparotomy with gastrotomy, dissection of the ulcer and suturing the vessel to be the operation of choice.
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In the period from 1985 to 1992 sixty-three patients aged from 7 months to 15 years were treated for the portal hypertension syndrome, 60 had the extrahepatie form. Forty-five various operations for portosystemic shunting were carried out: formation of proximal splenorenal anastomosis in 31, distal splenorenal anastomosis in 4, mesentericocaval anastomosis in 6, gastrocaval anastomisis in 2, and an atypical vascular shunt in 2 cases. Nonshunting operations were performed on 8 patients. Since 1986 39 sessions of endoscopic sclerotherapy were conducted, 16 of them were carried out in cases with esophagogastric bleeding.
The authors consider that predisposing factors in the development of the Mallory-Weiss syndrome include restriction of mobility of the mucous and submucous layers of the cardia in relation to one another, uncoordinated and oppositely directed contractions of differently oriented muscle layers of the lower third of the esophagus and cardial portion of the stomach, incompetence of the cardial closing apparatus. Rupture of the wall of the stomach and duodenum is associated with an immediate dramatic change of the intragastric pressure. The endoscopic method of examination is thought to be the leading one in diagnosing the Mallory-Weiss syndrome.
The article analyzes an experience with treatment of 18 children with the Mallory-Weiss syndrome. Six children were operated upon, one of them died. Questions of pathogenesis of this syndrome in children practice are considered on the basis of anatomo-physiological properties of the child's organism. Attention was paid to the diagnostic and medical role of endoscopy. The tactics of treatment of this disease is recommended based on reference of the blood loss degree and findings of the endoscopic examination.
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