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Biomedical subjects

V D Fedorov

Publications and source records attributed to V D Fedorov.

At least 73 records · Page 4Linked to original sources
PubMed1990

[Characteristics of wound infection in long-term crush syndrome].

Clinicobacteriological examination was carried out in 31 patients with the crush syndrome (CS) and extensive damage to the soft tissues in combination with bone fractures complicated by wound infection. Inadequate surgical treatment in the early periods after the trauma (complete closure of the wound, making small incisions of the involved skin and subcutaneous fat) is particularly hazardous in such cases because it leads to the development of severe wound infection. This disease is marked by a complex polymicrobial structure of the causative agents, massive dissemination of aerobic and opportunistic anaerobic bacteria in the purulent focus (10(7)-10(9) microbial bodies), and a high proportion (48.4%) of obligate anaerobic microflora. Wound infection in the CS takes a grave clinical course, but without profound microbiological study it is difficult to differentiate it into aerobic and anaerobic (clostridial and ++non-clostridial) forms. This is evidence of the need for emergency extended bacteriological diagnosis at all the stages of treatment. "Pure" aerobic infection was identified in half of the patients and mixed aerobic-anaerobic infection in the other half. The possibility of the involvement of asporogenic anaerobes is shown (35.5% of cases). The high risk of the development of gas gangrene is detected (9.7%) and its is concluded that early prevention is necessary by adequate surgical intervention, adequate intensive antibacterial and detoxification therapy, including hyperbaric therapy. The efficacy of current antigangrene immunization agents must be evaluated.

Armenia↗
PubMed1990

[Combined surgery of the large intestine and biliary tract].

The article deals with the experience in the treatment of 204 patients with diseases of the biliary tract who underwent operation for various diseases of the colon. In 147 of them intervention on the colon was carried out simultaneously with cholecystectomy and other operations on the biliary tract. In 57 patients the gallbladder was not removed and in 7 (12.2%) of them the immediate postoperative period was marked by the development of complications connected with a disease of the gallbladder. As a result 3 out of the 57 patients were operated on for a second time. The frequency of postoperative complications among patients who were subjected to combined operations was 46.9%, the death rate--4.8%. It is important to point out that these indices hardly differed from those in the general group of patients (4.2% and 4.8%, respectively). Thus, cholecystectomy combined with intervention on the colon is admissible and, undoubtedly, expedient because it prevents the development of complications of cholelithiasis in the early postoperative period and saves the patient from undergoing a second operation on the biliary tract later.

Cholecystectomy↗
PubMed1990

[Simultaneous radical surgery in patients with cancer of the rectum with metastases to the liver].

From 1972 to 1987, a total of 3.033 operations were carried out for carcinoma of the rectum at the Research Institute of Proctology. Various types of resection of the liver were conducted in one stage in 51 cases. The postoperative mortality in the group of patients who underwent operation in association with resection of the liver was 5.9%, which was only slightly higher than that in the general group of patients with rectal carcinoma (4.9%) operated on in the same period of time. Among 35 patients dismissed from the clinic after removal of verified metastases of the liver 15 had been operated on more than 5 years ago. Four of them have a survival period of more than 5 years and 2 have a survival period of over 10 years. On basis of their experience, the authors claim that the performance of one-stage radical operations for rectal carcinoma with removal of solitary metastases from the liver is admissible and, most probably, expedient.

Adult↗
PubMed1990

[The organization of care for burn victims in catastrophes].

The experience in medical care and treatment of burned patients showed that adequate anti-shock infusion therapy can be established only 4-6 hours after the sustained trauma. However, even despite such a delay, many burned patients (75-80%) get well, due to the later adequate complex treatment controlled by experienced burn specialists [correction of combustiologists] in hospital units specially organized and equipped for this category of patients. Within the first 2-4 days after the trauma, it is recommended to distribute major accident victims between different specialized burn units, using specially equipped air and motor transportation vehicles.

Burn Units↗
PubMed1989

Combined treatment of colonic cancer.

One hundred seventy-eight patients with cancer of different segments of the colon were treated with preoperative radiation and surgery. Preoperative radiation with 25 MeV betatron was employed according to the method developed by the authors. Radiation treatment was tolerated by patients in the absence of manifest general and local reactions. No decrease below 3000 in the rate of leukocytes was observed after a total dose of up to 40 Gy. After radiotherapy, improvement in the general state was achieved in 72 percent and positive roentgenologic findings were seen in 70.8 percent of patients. The preoperative irradiation therapy was followed by 153 radical and 28 palliative operations. There was no increase in postoperative morbidity or mortality. The morphologic study of surgical specimens showed that considerable changes in the tumoral tissue, including disappearance of cancer cells, were seen in 75 percent of cases. The five-year survival rate of 112 patients after radical surgery indicates that it is worthwhile to use the combined treatment approach for tumors located in the right colon and in cases of suspected or existing infiltration into adjacent organs and tissues.

Adult↗
PubMed1989

Treatment of patients with rectal cancer.

During a 20-year period (1965 to 1985), 4673 patients with rectal cancer underwent surgical treatment, with 3500 of them being subjected to radical surgery. Postoperative mortality was 6.1 percent. During the last five years, the mortality rate decreased dramatically down to 4.9 percent, despite an increase in the group of elderly patients (35.7 percent) and performance of a considerable percentage of simultaneous, extensive, and combined operations (33.7 percent). The trend of employing sphincter-saving operations (in more than 60 percent of patients, the anterior resection and abdominoanal resection with a pull-through were performed) accounts for the favorable five-year survival rate (62 to 69 percent) and results in a good functional outcome in 80 percent of patients. The use of a combination of conservative and operative methods of rehabilitation contributes to the professional readaptation of 75 to 80 percent of patients after surgery with construction of a stoma. In 223 cases, a Soviet magnetic occlusive device was implanted, while in 67 patients an artificial sphincter mechanism was constructed from the flap of the adductor longus femoris muscle. It should be emphasized that surgical methods of rehabilitation are used both in primary and reconstructive operations. The experience with management of 124 patients with recurrent cancer after resection and extirpation of the rectum shows that local excision or repeated resections of the rectum cure 20 to 29 percent of those operated on.

Aged↗
PubMed1989

Results of radical surgery for advanced rectal cancer.

During the period 1972 to 1987 inclusive, 313 multivisceral resections in advanced rectal cancer were performed, accounting for 10.3 percent of all radical surgical interventions for this disease. Of these resections, 71 were for distant metastases and 242 for tumor infiltration to adherent organs. The postoperative mortality was 5.4 percent, which was not significantly different from that in the total group of patients with rectal cancer (4.9 percent) operated upon during the same period. After multivisceral resections, 49.5 percent of patients developed postoperative complications. In the total group of patients with rectal cancer, the postoperative morbidity was 30.3 percent. Long-term results were assessed in 190 patients who had been operated upon more than five years ago. It has been established that 42.1 percent of patients lived more than five years after multivisceral resections. Hope is inspired by the fact that of 15 patients with hepatic metastases (26 percent) lived over five years following radical surgery. These data allow the conclusion that radical surgery for advanced rectal cancer is justifiable and advisable.

Adolescent↗
PubMed1989

[Reconstructive surgery in patients with nonspecific ulcerative colitis and Crohn disease].

The article analyses experience in reconstructive operations on 89 patients with unspecific ulcerative colitis and Crohn's disease in the period from 1960 to 1987. Most frequently, surgical rehabilitation of these patients proved to be possible when the time between the onset of the disease and the primary operation was no more than 3 years. Special selection of patients for reconstructive operations does not exclude those with complications in the anorectal region, the manifestations of which should be, however, minimal. The inflammatory process in the rectum should not exceed the first degree of activity. The most favourable periods for reconstructive operations are 6 to 12 months after removal of the colon. The best results were achieved in patients with ileorectal and a low ileosigmoid anastomosis which were created in 90% of patients with unspecific ulcerative colitis and in 41% of those with Crohn's disease.

Adult↗
PubMed1989

[Surgical tactics in extensive necrosis of the sigmoid which had been brought downwards].

Since 1982 the authors perform early (on the 4th-10th day) reoperations in extensive necroses of the sigmoid colon which had been transposed downwards after abdomino-anal resection of the rectum. The reoperation consists in resection of the affected segment of the intestine (usually the whole remaining sigmoid colon) and downward retransposition of the descending or the left half of the transverse colon. Nine such operations were performed; in 8 patients the results were favorable, one 70-year-old female patient died. The first operations had been performed for carcinoma (5 patients), endometriosis (one patient), and anorectal developmental anomalies (3 adult females). It proved that it is advisable to undertake downward retransposition as an emergency manipulation immediately after diagnosing extensive necrosis of the downward transposed sigmoid colon, which usually happens on the 4th-6th day after the main operation. The intestinal wall is still not undergoing disintegration in this period and there is no purulent melting of the areolar tissue of the walls of the true pelvis, i.e., the danger of purulent complications developing after downward retransposition is relatively small, particularly if the cavity of the true pelvis is drained abundantly and lavaged regularly with antiseptic solutions in the postoperative period. Such reoperations are especially advisable in individuals under the age of 60, and usually ensure favorable immediate and late-term functional results.

Adult↗
PubMed1988

[Morphostatistical characteristics of adenomas of the large intestine based on the data from 1915 autopsies].

Large intestine polyps have been revealed in 1372 cases of 1915 autopsies. 4.1% of these have been hyperplastic polyps, 86.2% tubular adenomas, 11.1% tubular-villous and 2.7% villous adenomas. Solitary adenomas have been less frequent than multiple one (42 vs. 58%). The adenomas have been equally incident in the right and left portions of the large intestine, but they have been larger and characterized by a higher degree of epithelial dysplasia in the sigmoid and rectum. Malignant adenomas made up 0.8% of the total number of tumors. Adenomas have been revealed twice more frequently in the patients who died in hospital than in the group of forensic medical autopsies. Multifactorial analysis has demonstrated a correlation between adenoma detection rate and some chronic diseases.

Adenoma↗