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Biomedical subjects

O S Shkrob

Publications and source records attributed to O S Shkrob.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Informative value of various diagnostic methods in Itsenko-Cushing syndrome].

The authors discuss the comparative evaluation of different methods of examination applied in 36 patients with the Icenko-Cushing syndrome. The results of the investigation are compared with the intraoperative findings and the data of morphological studies. MR-topography proved to be mist informative. Ultrasonic examination was highly effective in tumors measuring up to 1 cm in diameter. The use of USE during the operation hor locatind the tumor and determining its connection with the surrounding organs allows the operation to be performed in a shorter time and its traumatic character.

Adrenal Gland Neoplasms↗
PubMed1995

[Ultrasound diagnosis of breast nodules].

The authors show the comparative data on ultrasonic examination and mammography in 204 patients with nodular new growths in the breast: 66 had breast carcinoma and 138 had benign diseases. They suggest 6 ultrasonic criteria characteristic of breast carcinoma and describe the ultrasonic picture of the most commonly encountered benign breast tumors: fibroadenoma, nodular mastopathy, cysts. USE sensitivity was 68.8 +/- 7% in breast carcinoma, 82.6 +/- 8.1% in fibroadenoma, 72.8 +/- 7.2% in nodular mastopathy, and 100% in cysts (the respective values in mammography were 76.7 +/- 6.4%, 69.6 +/- 9.8%, 74.4 +/- 7%, and 60 +/- 11.2%). USE sensitivity and sensitivity of mammography were found to differ for different age categories in early forms of breast carcinoma. It is shown that the histological structure of a malignant tumor may be assumed from the ultrasonic criteria. The authors conclude that USE has a high diagnostic value in nodular new growths of the breast and that differential diagnosis of malignant and benign lesions is possible.

Adult↗
PubMed1994

[Pre- and postoperative ultrasonic study in gunshot wounds of parenchymal organs].

Timely discovery of the bullet or its fragments in the human body and determination of the character and size of the damage inflicted to the internal organs guarantee adequate treatment of the injured. USE makes it possible to exclude or recognize injury to the parenchymal organs (subscapular and intra-tissue hematomas, complete crushing of the organ), and to reveal free or bounded fluid in the abdominal and pleural cavities and in the retroperitoneal space. Moreover, USE may be applied for identifying the location of the bullet or fragment in he parenchymal organ, the subcutaneous fat or the retroperitoneal fat. Intraoperative USE proves to be of great aid in many cases because it allows complete examination of the structure of the internal organs and the abdominal spaces in all planes and the condition of the retroperitoneal fat. The article describes cases in which USE helped in precise localization of the bullet and in revealing the character of the damage, as the result of which an optimal plan of surgical intervention was chosen.

Abdominal Injuries↗
PubMed1994

[Thirty years of experience in the surgical treatment of patients with generalized myasthenia].

The article deals with 30-year experience of the Burdenko Facultative Surgical Clinic in surgical management of generalized myasthenia. The analysis is based on 2,500 cases. This complex disease was worked out in stages, taking into account the advancements of the medical science in the given stage. It is noted that the immediate and late-term results of surgery improved after introduction of the newest methods of examination and treatment of patients with myasthenia into practice. Among these methods are CT and MRT, immunohistochemical study, and treatment with steroids and immunodepressants. The role and significance of sorption methods and splenectomy in combined treatment of serious forms of myasthenia are pointed out. The elaboration of the clinico-immuno-morphometric criteria allowed the authors to prognosticate the results of surgical treatment with high authenticity and distinguish two types of myasthenia, as a result of which the indications for surgery could be determined more precisely. The authors direct the way to further research in this field for improvement of the diagnosis and the results of treatment of generalized myasthenia.

Combined Modality Therapy↗
PubMed1994

[The informative value of various diagnostic methods in Itsenko-Cushing's disease].

The authors studied the informative value of various diagnostic methods: ultrasonic examination (USE), computed tomography (CT), magneto-resonance tomography (MRT), phlebography with separate collection of blood from the inferior vena cava and its hormonal investigation in Itsenko-Cushing's disease (52 cases). All patient underwent operation, and because of this the changes detected in the adrenals by various diagnostic methods of examination were compared with the morphological findings. Three patients were subjected to bilateral adrenalectomy. Morphological study of the adrenals revealed diffuse hyperplasia of the cortex in 17 cases, macro- and microadenomas in hyperplasia of the adrenals in 23, and diffuse-nodular hyperplasia in 15 cases. In macroadenomatosis identification, the informative value of MRT was 77.8%, CT 66.6%, and USE 22.2%. MRT was most informative in detection of microedenomatosis and diffuse-nodular hyperplasia--82.3% of cases; the respective values for CT and USE were 71.4% and 56.5%. The quantitative parameters of the adrenal tissue were studied in MRT: relaxation time (T-2) and the value of relative signal intensity (E). The value of relative signal intensity was lower in micro-macroadenomatosis than in diffuse and diffuse-nodular hyperplasia. The use of the quantitative parameters (T-2 and E) increases the diagnostic possibilities of MRT and provides for a more authentic idea of the character of the pathological changes in the adrenal tissue. Precise verification of the pathological process in the adrenal cortex allows the optimal treatment to be chosen, adrenalectomy to be considered in time, and the side of the operation to be correctly determined.

Adrenal Glands↗
PubMed1993

[Diagnosis, surgical treatment and prognosis in patients with generalized myasthenia].

The work deals with the clinical analysis of the richest experience in the surgical treatment of patients with generalized myasthenia in the country. The efficacy of various methods for the diagnosis of affection of the thymus is studied comparatively. It is shown that for more effective diagnosis of neoplastic lesions of the thymus wider use of computerized and magneto-resonance tomography is expedient and that they must replace the insufficiently informative and invasive examination methods used today (pneumonodiastinography, phlebography, scintigraphy, etc.) which still form the basis for the system of diagnostic research in patients with myasthenia. The authors determined the indications and contraindications for, the optimum terms for undertaking the surgical intervention and its volume in neoplastic and nonneoplastic diseases of the thymus in adults and children. Comparative evaluation of various means of preoperative management was conducted. It is shown that to improve the patient's condition and stabilize the myasthenic status on the possibly minimal doses of anticholesteremic agents glucocorticoid hormones should be included in the complex of preoperative management. The indications for hormonotherapy were determined. The efficacy of plasmapheresis, radiotherapy, and glomectomy with denervation of the sinocarotid zone was evaluated and their place in the complex treatment of patients was determined. From study of the late-term results of treatment of a large group of patients (children, adults with a thymus) the main causes of unsuccessful surgical treatment of generalized myasthenia were identified and the concrete means of improving the results of treatment were planned. Two types of changes in the clinico-immuno-morphological values were revealed in patients with generalized myasthenia, differing evidently in pathogenesis. New clinico-immuno-morphological correlations and prognostic factors were discovered, and a method for prognosticating the effect of thymectomy was suggested. It is shown that splenectomy has a favorable effect in the most severe category of patients in unsuccessful operative and nonoperative treatment. The tactics of management of patients accepted in the clinic led to a uncomplicated course of the postoperative period in the majority of patients in the last years.

Adult↗
PubMed1993

[Comparative evaluation of diagnostic methods in thymus disease].

From analysis of the case records of 2,000 patients with the generalized form of myasthenia, who underwent operation at the surgical faculty clinic of the Moscow Medical Academy, the authors discuss in detail the results of using a wide spectrum of methods for examination of the thymus, including: pneumomediastinography (PMG), scintigraphy, phlebography, computed and magnetoresonance tomography (CT and MRT). Taking into account the sensitivity and specificity of each of these methods, the indications and contraindications, and the degree of invasiveness, the authors concluded that MR tomography is the method of choice for examination of the thymus. It yields the rechest information and is most simple and safe for the patient. They also noted that CT made it possible to locate the pathological process more exactly, and provided additional information on the degree of the invasion, the presence of implants, and the condition of the other mediastinal organs. The indications for phlebography of the thymus and PMG are limited because of their invasiveness, difficult techniques, high risk of complications, and relatively low informativeness. Scintigraphy of the thymus is the least informative examination method. In view of the high percentage of pseudopositive and pseudonegative results, it may be concluded that its use for detecting lesions of the thymus in patients with myasthenia is hardly expedient.

Humans↗
PubMed1993

[Intraoperative ultrasonography in Itsenko-Cushing's disease and syndrome].

Ultrasonic study conducted during an operation is finding wider use lately. Surgery is the main method of treatment of most diseases of the adrenals, therefore problems of topical intraoperative diagnosis are very urgent. Twenty-three patients were operated on for Itsenko-Cushing's disease and syndrome and tumors of the retroperitoneal space at the Faculty Surgical Clinic of the Moscow Medical Academy within a period of 12 months. All patients were subjected to complex ultrasonic examination, including pre-intra- and postoperative study. Intraoperative ultrasonic study was conducted in two stages: stage 1--examination after thoracotomy through the diaphragm for choosing the optimal place and length of phrenotomy; stage 2--ultrasonic examination after phrenotomy to localize precisely the adrenal or tumor and reveal their connection with the adjacent organs and vascular structures. Complex ultrasonic examination has advantages over the other examination methods (computed tomography, angiography, scintigraphy) which allows it to come to the forefront in the diagnostic search for adrenal tumors. Intraoperative ultrasonic examination makes it possible for the surgeon to avoid wide phrenotomy and prolonged investigation, reduces the possibility of inflicting injury to the large vessels, which reduces the duration of the operation and anesthesia, and improves the course of the postoperative period.

Adult↗
PubMed1992

[The choice of an optimal variant in the reconstructive stage of gastrectomy].

The authors analyse 40-year experience in gastrectomy and extirpation of the gastric stump in carcinoma of the stomach. Operations were performed on 742 patients. The results show that the mechanical suture has advantages over the manual suture in the formation of the esophago-intestinal anastomosis. The functional results were found to be best when the continuity of the gastrointestinal tract was restored by establishing the esophago-intestinal anastomosis with a loop of the small intestine isolated according to Roux. Comparative appraisal of end-to-end and end-to-side esophago-intestinal anastomoses revealed the advantages of the last-named in relation to the incidence of postoperative complications and total outcomes. The effect of the surgeon's qualification on the frequency of postoperative complications is discussed.

Adult↗
PubMed1991

[Magnetic resonance tomography in the diagnosis of surgical diseases].

The authors analyse the first experience in the use of magnetic resonance tomography (MP-tomography) in the diagnosis of some surgical diseases. MR-tomography of the mammary gland (257 patients), thymus (55 patients), adrenals (41 patients), and hypophysis (18 patients) was conducted. The results of the examination were compared with the findings of other diagnostic methods and verified intraoperatively and histologically. The authors claim that the high informativeness of MR-tomography, its noninvasiveness, the absence of a radiation load, and the possibility of repeating the examination many times in three mutually-perpendicular planes distinguish the method favorably and dictate the necessity of its further study in clinical medicine.

Adrenal Gland Diseases↗
PubMed1991

[Intraoperative ultrasonographic examination in surgery of the biliary tract].

The diagnostic value of intraoperative ultrasonic examination (IUSE) in surgery on the biliary tract was shown from analysis of the literature and the authors' experience. IUSE in more than 300 patients demonstrated a high resolving power in the diagnosis of choledocholithiasis and the absence of radiation load, allergic reactions and complications. In comparison of IUSE with intraoperative cholangiography in the diagnosis of stones in the gallbladder the total efficacy of the methods was 98.2% and 92.6%, respectively. IUSE has no side effects, is a simpler and cheaper method of examination, and allows goal-oriented removal of stones from the biliary tract. It is shown that with accumulation of experience in IUSE the performance of intraoperative cholangiography can be brought to the minimum.

Adult↗
PubMed1991

[Generalized suppurative peritonitis in patients with destructive forms of acute appendicitis].

The authors undertook comparative analysis of the results of treatment, the number and intensity of postoperative pyo-inflammatory complications, and the mortality rate in a group of 51 patients with generalized purulent peritonitis of appendicular origin in various methods of abdominal cavity cleansing: closed drainage of the abdominal cavity (group I, 10 patients); continuous peritoneal lavage (group II, 15 patients), cleansing of the abdominal cavity in stages (group III, 26 patients). Any type of cleansing did not exclude the development of purulent complications during treatment, the whose number grew with the increase in the period between the appendectomy and the onset of the disease. Complications developed in 23 patients (45%). Their frequency and intensity were, however, much less when the abdominal cavity was lavaged in stages, which enable the number of cases of adhesive obstruction and the formation of abscesses between the loops to be reduced markedly. A progressive septic process and poly-organic insufficiency were the main causes of death. The mortality rate was 30; 26.6 and 11.5%, respectively, in groups I, II, and III.

Acute Disease↗
PubMed1991

[Diagnosis and surgical treatment of myasthenia gravis in childhood].

Thirty-year experience in surgical treatment of myasthenia in children and adolescents (175 patients) is generalized. It provides evidence of delayed recognition of this disease in many patients and of prolonged, often ineffective nonoperative treatment. Operation for thymectomy should be one of the main methods for the management of myasthenia in children. Operative treatment is indicated in a disease of moderate severity or in a severe course of myasthenia, particularly in patients with the first type of immunomorphological changes. It is important to amend the myasthenic disorders before the operation by means of maximally possible doses of anticholinesterases with addition of corticosteroids, whenever necessary. Whatever the method of treatment chosen, the patients must be kept under skilled dynamic control. Excellent and good late-term results were produced in 84.6% of cases.

Adolescent↗
PubMed1991

[Tactical and technical errors in surgical treatment of patients with generalized myasthenia gravis].

From experience in surgical treatment of 1,800 patients with generalized myasthenia as well as from literature data, the authors analyse the main tactical and technical errors in the treatment of this category of patients. A complex approach and a program of improving the results of treatment of patients with myasthenia were elaborated. Compulsory examination of the mediastinum for revealing possible affection of the thymus is indicated in myasthenia. Median sternotomy with ++extra-fascial removal of the whole thymus is considered the optimal approach in thymectomy. Thymomthymectomy with extensive removal of the areolar tissue of the anterior mediastinum is believed to be the operation of ++choice in tumors of the thymus. Thymus tissue which is not removed during the operation is one of the causes of recurrent myasthenia, while unjustified extension of the volume of the operation in nonneoplastic affection of the thymus is also inadvisable. Preoperative radiotherapy is not recommended. The principles elaborated in the clinic enabled the authors to reduce the frequency of assisted ventilation sevenfold and the incidence of infectious complications, pneumonia among others, to 0.6%.

Adult↗
PubMed1991

[Residual thymus gland in patients operated on for myasthenia].

The authors studied the causes of ineffective surgical treatment of myasthenia and found residual thymus to be one of them. From analysis of 21 cases in which part of the thymus was not removed (in 19 cases the diagnosis was verified histologically), they drew the conclusion that the causes of residual thymus may be technical errors due to inadequate choice of the surgical approach of the surgeons' insufficient experience, in removal of a thymoma failure to excise part of the thymus not involved in the tumor, incomplete knowledge of the role of the thymus in the pathogenesis of myasthenia and its incomplete removal in thymectomy in patients with generalized myasthenia. Uneventful postoperative course was noted in 11 patients, crises with respiratory disorders in 6 (prolonged artificial lung ventilation had to be resorted to in 4 of them), suppuration of the wound in 2, and pneumonia in 1 patient who was under artificial lung ventilation. The late--term results were studied in follow--up periods of 12 months to 15 years. The myasthenic status improved in all patients, the results were excellent and good in 15. In view of the difficulty in establishing the diagnosis and management, this grave category of patients must be treated at specialized centers.

Adolescent↗
PubMed1991

[Plasmapheresis in combined treatment of severe generalized myasthenia].

Experience in the application of plasmapheresis in various stages of treatment is analysed. It was conducted in 52 patients with severe forms of generalized myasthenia; 12 of them were males and 40 were females. It is noted that plasmapheresis is very effective in the preoperative period for the preparation of patients for operation and is ineffective in medicamentous therapy. In the late-term periods after thymectomy plasmapheresis is mainly recommended for arresting crises and precritical conditions because of the rapid and short effect of the method. In patients who underwent thymectomy and splenectomy the effect of plasmapheresis in the late-term period after the operation was of a longer duration. Research must be continued and clinical experience accumulated to identify exactly the mechanism of the effect of plasmapheresis on the myasthenic status and the immune and neuroendocrine systems and to determine the place of the method in the complex of therapeutic measures.

Adult↗