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Biomedical subjects

V K Gostishchev

Publications and source records attributed to V K Gostishchev.

At least 19 recordsLinked to original sources
PubMed1996

[Immune system defence and its correction in patients with chronic inflammatory disorders of lower extremities].

The factors of immune defense were studied in 83 patients. Chronic osteomyelitis of foot and shin was in 48 patients (hematogenic osteomyelitis in 36 patients, posttraumatic osteomyelitis-in 12 patients). Trophic ulcers were in 25 patients: in 36% in the presence of diabetes mellitus; diabetic angiopathy complicated with diabetic gangrene was in 10 patients. The complex of immune and morphological changes, developing chronic inflammation underlying chronic course of disease, have been detected by clinical trials. The development of immune insufficiency makes it necessary to use various methods of immunocorrection (pharmacological, biological, physical) in treatment of such patients that will decrease rate of postoperative morbidity and improve results of treatment.

Adult↗
PubMed1994

[Pathogenetic rationale and basic principles in the comprehensive detoxifying therapy of purulent peritonitis].

The multimodality therapy for patients with purulent peritonitis and Degrees II-III endotoxicoses involves efferent methods of detoxification and hemocorrection alone and in combinations with hemosorption (HS), plasmapheresis (P), ultraviolet autoblood radiation (UVAR), immunocorrection through extracorporeal donor xenosplenic inclusion (EDXSI) or xenoperfusate infusion (XPI), indirect electrochemical detoxification (IECD) of blood and exfused plasma by the use of sodium hypochlorite (NaClO) obtained on an EDO-1 electrochemical unit. The analysis of therapeutical results has indicated that the efferent methods should be included into the multimodality therapy only in Degrees II-III endotoxicoses when a considerable number of toxic components leading to the development of organ- and system-specific insufficiency accumulate in the patients' circulatory systems. With this, the obligatory conditions are an adequate sanitation of the abdomen with the topical application of NaClO as an antiseptic and a fibrinolytic, rational antibacterial and homeostatic corrective therapy. The combined use of the efferent methods (HS+UVAR; HS+XPI; P+IECD of plasma) in the programmed mode is pathogenetically grounded, which produces a potentiating detoxifying effect, and levels the negative aspects of each method alone. P is preferable when it is used alone (in case of adequate plasma replacement. A comprehensive therapy policy has been developed in accordance with the stage of peritonitis and the degree of endotoxicosis.

Adolescent↗
PubMed1994

[Adverse reactions and complications of splenic perfusions: intensive therapy, prevention].

The authors analysed the complications and side reactions in extracorporeal connection with a donor xenospleen (ECCDS) and infusion of a xenosplenoperfusate in 205 patients with surgical purulent infection. In 127 patients ECCDS was conducted during traditional premedication (atropine 4 trimeperidine hydrochloride injected into a muscle 30-40 minutes before the procedure), in which case complications like anaphylactic shock, laryngo- and bronchospasm, Lyeil's syndrome, and angioneurotic edema occurred. ECCDS and infusion of a xenosplenoperfusate in 78 patients who received multicomponent premedication had practically no complications. Experience showed that multicomponent premedication including a complex of antihistaminic agents (diphenylhydramine hydrochloride++pipolphen+suprastin) and corticosteroids is a measure of reliable prevention of anaphylactic reactions both in primary and repeated xenosplenoperfusions. In severe endotoxicosis, immunocorrection by xenosplenoperfusion is most effective and safe (particularly in repeated procedures) when combined with preliminary efferent detoxification (hemosorption, exchange plasmapheresis) and multicomponent premedication.

Adrenal Cortex Hormones↗
PubMed1994

[Diagnosis and surgical treatment of foot osteomyelitis].

The article analyses the results of surgical treatment of 227 patients with osteomyelitis of the foot bones. The peculiarities of the course of the disease, determined by the anatomical and functional features and the concomitant pathological conditions, are evaluated. Comparative appraisal of various methods of examination showed the radionuclide method to be most informative. The peculiarities of surgical operations in pyoinflammatory diseases of the foot bones, which are due to the necessary preservation of a segment of the foot for subsequent correction, call for obligatory application of combined necrectomy and a complex of agents with polyfunctional activity in addition to the traditional mechanical methods of treatment of the bone defect. The results of complex treatment were good in 72%, satisfactory in 23%, and poor in 5% of patients.

Adult↗
PubMed1994

[Indirect electrochemical detoxication in the combined treatment of purulent diseases in surgical practice].

The method of indirect electrochemical detoxification by means of sodium hypochlorite (NaClO) obtained by isotonic NaCl solution electrolysis on a [symbol: see text] device consists in modeling hepatic monooxygenase detoxifying function on cytochrome B-450. Indirect electrochemical detoxification was conducted in more than 200 patients with generalized abdominal pyo-inflammatory processes and marked intoxication syndrome. Sodium hypochlorite was used for intravenous treatment of endotoxicosis in concentrations of 600 mg/l and 300 mg/l in volumes of 1/10 and 1/6 CBV in patients with generalized fibrinopurulent peritonitis and pancreonecrosis and for local administration during programmed prophylactic treatment of the abdominal cavity. The detoxifying effect was best in patients with grade 2-3-intoxication (according to V. K. Gostishchev et al., 1989). Local use of NaClO was marked by a high necrolytic effect, antiseptic properties, capability for reducing the resistance of the microflora to antibiotics, etc. The work discusses the methods of hypochlorite application, indications, contraindications, possible complications and their prevention.

Adult↗
PubMed1993

[The polymer sorbent regenkur in the treatment of suppurative wounds].

Clinico-laboratory tests of the new Soviet polymer sorbent Regenkur obtained on the basis of rarely cross-linked cellulose ester were conducted on 60 patients with acute purulent diseases of the soft tissues in the surgical clinic, Sechenov Medical Academy. In treatment with sorbent applications the number of microorganisms reduced by several factors on the 3rd-5th day; on the average, the term of wound cleansing was 4.6 days, granulations appeared on day 4.3 and peripheral epithelialization on day 6.5. The duration of hospital stay decreased by one third. Advantages of the new sorbent over those of the well-known foreign analogue Debrizan were revealed.

Adult↗
PubMed1991

[Effects of intravascular laser irradiation of blood on the state of the immune system of patients with chronic osteomyelitis].

The authors discuss the results of study of the immune status in 55 patients with chronic osteomyelitis, it was found that the condition of the patients' immune system reflects the duration and severity of the disease and the individual reactivity of the organism. The inclusion of laser treatment in the complex of therapeutic measures should be based on appraisal of the condition of the immune system and conducted under dynamic immunological control. In deficiency of the thymus-dependent immunity the sessions of blood intravascular laser irradiation activate the organism's defence forces and facilitate correction of the imbalance in the system of the regulating cells. Laser irradiation of blood in mild changes of the immunological status is expedient because it may lead to negative dynamics of the immune system. Attainment of an optimal immunological condition in the preoperative period is conductive to a favourable course of the postoperative period and a favourable outcome of the disease.

Adolescent↗
PubMed1991

[Acute cholecystogenic suppurative cholangitis].

The authors discuss the results of clinical, instrumental, and microbiological examinations of 240 patients suffering from purulent cholangitis in acute cholecystitis. Choledocholithiasis was the main cause of the development of purulent cholangitis in 90.8% of patients. A classification of cholangitis and the clinical signs of the disease are dwelt upon. Endoscopic decompression of the biliary tract in the preoperative period is an obligatory condition for performing laparotomic operation. A complex of detoxification measures and general and local (prolonged flow dialysis of the biliary tract) antibacterial therapy are indicated in the postoperative period. All the measures led to decrease of mortality rates in cholecystogenic purulent cholangitis from 19.5 to 6.2%.

Acute Disease↗
PubMed1991

[Neutrophilic leukocyte reaction in the course of diffuse purulent peritonitis].

Peritoneum biopsies from patients with various stages of peritonitis were studied electron microscopically. As distinct from the widespread opinion of a significant phagocytic activity of neutrophil leucocytes in early peritonitis this activity was not found. The authors consider this as a cause of peritonitis progression and fatality of the disease in the absence of surgical treatment. Phagocytic activity is restored after the elimination of the causative factors, i.e. after the sanative operation.

Biopsy↗
PubMed1991

[Pathogenesis of trophic ulcers in varicose veins of the lower extremities].

The work generalized the results of examination of 418 patients with primary varicosity (V) complicated by trophic ulcers. On the basis of the study conducted by the authors, a conception of pathogenesis is suggested, the main links of which are microcirculatory disorders in the system of perforating veins of a closed structure, and deficient resolution of fibrin due to diminished local fibrinolytic activity of the plasma. Insufficient fibrin splitting leads to the formation of paravasal collagen cuffs preventing normal exchange between the capillaries and tissues. Impaired nutrition facilitates spasm of arteries and arterioles, whose genesis magnesium deficit contributes to. Activation of collagenolytic peptidases-cathepsins, D, A, B occurs in the ischemic tissues, which leads to destruction of the skin and the formation of ulcers. The disease is attended by disorders of immunity (secondary immunodeficiency), which reduces the reparative processes and thus promotes the development of a chronic process. A complex approach to the treatment of V in the presence of trophic ulcers is suggested.

Adult↗
PubMed1991

[A comparative evaluation of hyper- and normovolemic hemodilution in the complex treatment of chronic hematogenic osteomyelitis].

The article deals with the comparative analysis of the results of treatment of 98 patients with chronic hematogenic osteomyelitis of the long tubular and pelvic bones with the use of hypervolemic and normovolemic hemodilution as a method of infusion-transfusion therapy of intraoperative blood loss and its compensation with donor blood. It is shown on the basis of clinical evaluation and the study of hemodynamic, hematological, and rheological blood values, the values of the blood coagulation system and the acid-base balance that the use of hypervolemic hemodilution is limited and can be applied in blood loss not exceeding 10% of the circulation volume. The use of the method of normovolemic hemodilution makes the transfusion of donor blood unnecessary and thus allows the complications associated with it, infectious among others, to be avoided. It can be used in blood loss of up to 20% of the circulation volume.

Adult↗
PubMed1991

[Diseases of the major duodenal papilla as a cause of post-cholecystectomy syndrome].

Analysis of 460 patients suffering from the postcholecystectomy syndrome (PCS) revealed an abnormality in the major duodenal papilla (MDP) in 32.4% of them. The development of PCS in this group of patients was caused by coexistence of several pathological processes, which was established in 71% of patients with diseases of the MDP. The most frequently encountered conditions were papillitis (59.1%), cicatricial stenosis (56.3%), and stones (14.7%). Papillitis plays a double cause-effect role in PCS: as a primary chronic disease it may lead to cicatricial stenosis of the MDP, and, on the other hand, it may be a consequence of choledocholithiasis, cholangitis, and other diseases. Endoscopic papillosphincterotomy is the most effective method for the treatment of PCS caused by MDP diseases; it makes it possible to reduce significantly the number of repeated abdominal operations.

Aged↗
PubMed1990

[Autologous blood transfusion in the complex surgical treatment of chronic hematogenic osteomyelitis].

The article analyzes results of complex surgical treatment of 109 patients with chronic hematogenic osteomyelitis of long tubular bones and pelvis, 53 of them were subjected to correction of intraoperative blood loss with autogenic blood. Autohemotransfusion with procurement of 400-600 ml of blood immediately before operation in combination with normovolemic hemodilution allows to correct intraoperative blood loss up to 20% of the circulating blood volume. Autohemotransfusion with the preliminary taking of blood as much as 800 ml allows to correct intraoperative blood loss more than for 20% of the circulating blood volume.

Adolescent↗
PubMed1990

[Pathogenesis of varicose ulcers of the lower extremities].

The article discusses the biochemical mechanisms of skin destruction and ulcer formation in patients with varicosity of the lower limbs. Cathepsins A, B, C, and D were determined in the skin in various parts of the limb in 57 patients: in the lower third of the leg the activity of cathepsin D was increased by 183.8%, that of cathepsin B by 140.2%, and the activity of cathepsin B by 239%. On basis of the data obtained the authors conclude that cathepsins take part in skin destruction. Increased activity of cathepsin D plays the initiative role in this process. Cathepsin activity reduced after 14-16 day treatment with aescusan; D by 24.1%, B by 17.7%, and A by 15.4%. The authors link the effect of the treatment with the protective effect of the preparation on the lysosomal membranes.

Cathepsins↗