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Biomedical subjects

P S Vetshev

Publications and source records attributed to P S Vetshev.

At least 19 recordsLinked to original sources
PubMed2001

[Diagnosis and surgical treatment of arterial hypertension of adrenal origin].

230 patients with arterial hypertension of adrenal origin were treated. 205 of them underwent adrenalectomy with surrounding paranephral fat. There were no lethal outcomes. Endogenic adrenocorticism was diagnosed in 134 patients. Cushing's syndrom was in 96 patients, Cushing's disease--in 34, ACTH-ectopic syndrome--in 2, adrenocortical cancer--in 2. Primary hyperaldosteronism was diagnosed in 42 cases: idiopathic hyperaldosteronism in 23 patients, aldosteronproducing adenoma (Conn's syndrome)--in 19. Tumors of chromaffine tissue were defected in 30 patients. All the patients underwent complex examination (hormonal profile, US, CT, MRT, angiography if it was necessary). Symptomatic arterial hypertension of adrenal origin was diagnosed during one year in 10% patients only because of absence of typical clinical picture. Use of complex examination has permitted to make a correct topical diagnosis and to choose optimum treatment policy in all the cases.

ACTH Syndrome, Ectopic↗
PubMed2001

[Cholecystectomy by mini-approach in the treatment of cholelithiasis].

Along with wide-spread laparoscopic cholecystectomy, cholelithiasis can be treated with another sparing technique--miniaccess cholecystectomy (MACE). Case histories and long-term treatment outcomes were analysed for 168 patients aged 23-77 years subjected to MACE with elements of open laparoscopy for chronic calculous cholecystitis. Surgery was made using a special surgical kit "Mini-assistant" by the team of two surgeons and an instrument nurse. After MACE the patients resume their jobs after a shorter period of inability, suffer from side effects of surgery in rare cases, have higher quality of life than patients after laparoscopic cholecystectomy.

Cholecystectomy↗
PubMed2000

[Laparoscopic and standard cholecystectomy: comparison of immediate results].

The advantages of laparoscopic cholecystectomy (LChE) are undoubtable in comparison with traditional one. However the experience showed, that LChE is not devoid of some shortcomings. It is characterized by the same typical complications as in ChE, besides it may be followed by some specific complications. The literature concerning the rate of complications in LChE are controversial. The comparative analysis has been carried out concerning the rate of complications after ChE (6800 operations) and LchE (900). The mean age of patients with choledocholythiasis--61.4 years. 40% of the patients had severe accompanying diseases coronary artery disease, complicated forms of arrythmia, arterial hypertension, diabetes mellitus, obesity. There were no significant differences between patients who underwent ChE (group 1) and LChE (group 2) by their age and the rate of accompanying diseases. Intraoperative cholangiography was performed in 3.5% of cases of group 1 and in 1.1%--in group 2. The average rate of the operations on extrahepatic bile ducts in group 1 was also lower--choledocholithotomy was carried out in 2.7%, transduodenal papillosphyncterotomy--in 1.7% of cases, drainage of the choledochal duct--in 1.9%. Combined operations were carried out in 10% of patients of group 1 and in 9.1% cases of group 2. The rate of intraoperative bleedings which demanded repeated operations made up in patients of group 1 0.1%, in patients of group 2 0.5%. Intraoperative damage of the choledochal duct in group 1 were detected in 0.14% and in group 2--in 0.11% of cases (the only complication of LChE in a patient was assessed as a endogenous wall clipping).

Cholecystectomy↗
PubMed2000

[Intraoperative ultrasonography in surgery on organs of abdominal cavity and retroperitoneal space].

Since 1984 to 1999 intraoperative US examination (IOUSE) was made in 863 patients. 236 of them had diseases of the liver, 137 diseases of the gall bladder and biliary tract, 158 pancreatic disorders, 151 diseases of gastro-intestinal tract, 72 diseases of the adrenal glands, 101 constitutional obesity, 3 splenic disorders and 5 gunshot wounds of the organs of the abdominal cavity and the retroperitoneal soft tissues. In masses of the liver IOUSE showed limits for resection of the liver, location of the diseased area with the vessels and biliary ducts, unpalpablefoci. OUSE allowed to perform US-guided puncture and sclerosizing small metastatic nodes as well as a puncture and antiparasitic treatment of inaccessible echinococcal cysts. In cholelithiasis IOUSE allows to reveal or to rule out the presence of the concrements in bile ducts. In cases of diseases of the pancreas IOUSE helps to localize pathologic area, defines its interrelations with adjacent major vessels and ducts, reveals unpalpable masses and enables US-guided puncture of the major pancreatic duct followed by its further opening. In gastric tumors it is possible under US control to determine precisely the limits of the infiltration of gastric wall which defines the volume for resection. In operation on the adrenals from thoracophrenolumbar approach IOUSE through the diaphragmatic cupula determines the place and the length of phrenotomy and elucidates interrelations of the tumor with adjacent organs. Sensibility of IOUSE made up from 87 to 100%, and specificity--92-100% depending on the disease.

Abdomen↗
PubMed2000

[Indications for surgical treatment of diffuse toxic goiter].

The results of examination and treatment in 129 patients with toxic goiter (TG) were analyzed. Thyroid status, stable intrathyroid iodine content, thyroid-stimulating hormone (TSH) receptor antibody titer, the volume and echostructure of thyroid tissue were studied either during their first visit and during conservative treatment. The findings suggests that the relapse rate is higher with slow reduction in thyroxine levels and prolonged suppressed TSH during treatment, with higher TSH receptor antibody titer after treatment, with large thyroid volumes when TG manifests it self and in the absence of positive changes in the volume and echostructure of thyroid tissue during treatment, with lower intrathyroid iodine content and its greater reduction during treatment. Earlier surgical intervention should be recommended 2 patients having these risk factors (their combination, in particular).

Adolescent↗
PubMed1999

[Adrenal tumors found by chance. Surgical treatment or follow-up?].

206 case records of the patients treated from 1985 to 1998 for various diseases of the adrenal glands were analyzed. In 39 (18.9%) patients tumors were chance finding at ultrasound examination or computer tomography of the abdominal cavity and retroabdominal space. 25 patients from this group were operated on, 14 patients were not operated and were followed up from 1 month to 7 years. All the patients underwent complex examination including analysis of the complaints, anamnesis and physical examination data, hormonal status examination (ACTH, hydrocortisone, 11-oxycorticosteroids, 17-ketosteroids, aldosterone, renin, adrenalin, noradrenalin, vanillyl-mandelic acid), device methods of examination USE, CT, MRT, superselective phlebography with separate catheterization of adrenal veins and blood intake per floor, fine needle aspiration biopsy under ultrasound control. Comparison of the results of complex clinical examination with morphological data of removed adrenal glands was carried out retrospectively. Arteriography and superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples, performed in 36 patients, enabled not only to supplement and define more exactly the other methods of topical diagnosis, but also to asses objectively functional actively of the affected and contralateral adrenal. Despite the fact that during the study of hormonal level in peripheral blood of patients it was normal analysis of the data obtained by superselective phlebography of adrenal veins and per floor taking of blood samples showed significant increase in hormones level in blood of all operated patients. Comparison of the data of superselective phlebography with separate catheterization of adrenal veins and per floor taking of blood samples and clinical picture of the disease made it possible to suggest the presence of preclinical (subclinical) Cushing or Conn syndrome. Operative treatment was not indicated in the absence of hormonal activity of the tumor (i.e. preclinical syndromes by Icenko-Cushing, Conn, pheochromocytoma, the virilizing and feminizing tumors), tumors of small size (less than 3 cm), in absence of malignant growth features confirmed by complex instrumental examination (USE, CT, MRT, fine-needle aspiration biopsy under US control, superselective phlebography with per floor taking of blood samples). Such patients were reexamined in 6 months. During the follow up period no changes of tumor size, homogeneity, hormonal status were revealed.

Adrenal Cortex Hormones↗
PubMed1998

[Thymomas with a myasthenic syndrome].

2560 patients with generalized myasthenia (Gm) were operated during 1960-1996. Tumors of the thymus (TT) which are the most often neoplastic masses of anterior mediastinum were revealed in 312 patients. Among them organ-specific tumors (thymomas, cancers) were detected in 252 patients (95.8%). Comparative analysis of effectiveness of a number of special methods of diagnostics of TT showed that CT and magnetic resonance tomography are the most sensitive and specific methods. Thymoma-thymectomy was carried out in 247 patients, among them in 93 (37.7%)--extended one. Postoperative lethality made up 5.1%, last years (1990-1996) there were no fatal outcomes. Among early postoperative complications wound infection was observed in 2.5% of patients, pneumonia--in 1.3%, myasthenic crisis--in 1.6%. Basing on histogenetic classification, following kinds of thymomas were singled out: in 58.9% cortical ("light cellular"), in 2.2%--medullar ("dark cellular") and in 38.9%--mixed cellular thymomas. Long-term results of thymectomy in patients with Gm in various kinds of thymomas were different: at the 5th year of follow-up they are worse in cortical cellular types and much better in medullar--cellular and mixed cellular thymomas with prevalence of medullar component.

Adult↗
PubMed1998

[Diagnosis and treatment of breast cysts].

The results of examination and treatment of 62 patients with breast cysts are presented. Basing on ultrasound and cytological examination evidence, indications and contraindications for puncture treatment of breast cysts with simultaneous 96% ethanol sclerosing with have been worked out. This treatment was carried out in 45 patients, the rate of recurrences being 11.1% compared to 21.9% in the control group. The puncture treatment is indicated in the mass of regular shape of homogenous unechogenous structure with symmetric "lateral shades" revealed by US examination, absence of atypical intracystic epithelium according to cytologic examination data. Contraindications for this method are the following: presence of intracystic growth, irregular shape of the cyst, asymmetric "lateral shades", polycystic disease of the breasts, cellular atypia revealed by cytologic examination, recurrent cyst, previuns mastectomy for breast cancer, atypical ductal or lobular hyperplasia revealed in sectoral resection.

Adult↗
PubMed1998

[Minimally invasive interventions in treatment of mechanical jaundice].

For the period from 1972 to 1997 676 transcutaneous transhepatic and 370 endoscopical interventions in 953 patients with mechanical jaundice were carried out. In 58.5% of cases jaundice was caused by malignancies, in 41.4%--by benign strictures of bile ducts. 40 external biliary bypasses, 427 external-internal biliary bypasses, 55 cholecystostomies and 154 operations of biliary endoprosthetic reconstructions were conducted under US control and TV imaging. In 33.5% of cases biliary bypass and endoscopical procedures were made as a preliminary stage of preparation of patients for operation or as a final method of treatment after conventional operation procedures, in 66.5% of cases it was final method of treatment. There were no deaths caused by biliary bypass procedures nor complications related to laparotomy. Thus low invasive interventions, undoubtedly, are the method of choice in mechanical jaundice for preparation of patients before radical operations as well as for relief of the course of disease in patients with inoperable cancer which causes obstruction of biliary ducts.

Aged↗
PubMed1998

[Cholecystectomy from mini-approach with the elements of open laparoscopic technique in surgical treatment of cholelithiasis].

The experience and the technique of cholecystectomy from mini-approach with elements of open laparascopic technique (MSE) in 102 patients with choledocholithiasis and calculous cholecystitis is descubed. In 99 cases the operation was carried out for chronic calculous cholecystitis, in 3 cases--for acute calculous cholecystitis. The patients were aged from 23 to 76 years (mean age 59.3 +/- 3.4 years). The average length of the incision in performing MSE made up 4.1 +/- 0.3 cm. Mean duration of the operation 42.4 +/- 5.3 min. In 5 cases (4.9%) intraoperative cholangiography was performed. The possibility to avoid the use of narcotic analgetics in postoperative period in patients who underwent MSE is demonstrated. Postoperative period made up 3.8 days. Social and cost-effect aspects of different modes of surgical treatment of patients with cholelithiasis are considered. The study of quality of life index makes it possible to come to conclusion about quicker return of the patients who underwent MSE to their habitual social and intellectual activities, practically complete absence of the influence of negative factors of conventional treatment (pains, dyspepsial, cosmetic defects) higher appreciation of their health conditions, well being, which manifests in higher quality of life in operated patients.

Adult↗
PubMed1997

[Potentialities of ultrasound examination in differential diagnosis of benign nodules and breast cancer].

The results of examination of 410 patients with nodular masses of the breast are analysed. Benign tumors were present in 314 (76.6%) of the patients, cancer of the mammary gland--in 96 (23.4%) of the patients. The tumors were classified into 3 types, depending on the intensity of the ultrasound wave behind the tumor. Based on the clinical and morphological analyses it was demonstrated that the presence of the acoustic wave behind the tumor is typical for the invasive cancer of the duct, scirrous carcinoma and lobular cancer. In medullar and mucosous cancer the intensity of the ultrasound wave does not change. In case of intracystic cancer the symptom of "back magnification" is present. The sensitivity of the ultrasound in detection of mammary gland cancer is 88.5%, specificity--96.5%. The analogous parameters of mammography are: 91.0% and 97.8%. In the use of ultrasound control in fine needle aspiration biopsy (FNAB) the sensitivity and specificity of the method increases from 88.5% to 92.7%. If the diagnosis of mammary gland cancer was established with the use of ultrasound and FNAB the additional use of mammography is not obligatory.

Adenocarcinoma, Scirrhous↗
PubMed1997

[Clinical and morphological analysis of adrenal cortex adenomas].

Case 31 patients with Cushing syndrome are analysed. On the basis of the number of the atypical cells from dark-cell adrenal cortex adenomas, giant-cell adenomas were differentiated as a separate morphological type. Blood concentration of hydrocortisone depends on the cell composition of adenomas. Clear-cell adenomas can be hormone-active and hormont-inactive. The quantitative parameters oblained NMR-tomography, allow detecting morphological type of the tumor with greaf accuracy.

Adolescent↗